Provider Demographics
NPI:1033163233
Name:MARIOLIS, ELAINE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:MARIOLIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4004
Mailing Address - Country:US
Mailing Address - Phone:732-826-5400
Mailing Address - Fax:732-826-5488
Practice Address - Street 1:252 SMITH ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4004
Practice Address - Country:US
Practice Address - Phone:732-826-5400
Practice Address - Fax:732-826-5488
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002595213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8730105Medicaid
NJ8730105Medicaid
NJU81631Medicare UPIN