Provider Demographics
NPI:1073389029
Name:ELCG MEDICAL LLC
Entity Type:Organization
Organization Name:ELCG MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:H
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-837-9215
Mailing Address - Street 1:6 NORTHWESTERN DR STE 105
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3416
Mailing Address - Country:US
Mailing Address - Phone:860-917-0019
Mailing Address - Fax:833-449-5031
Practice Address - Street 1:6 NORTHWESTERN DR STE 105
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3416
Practice Address - Country:US
Practice Address - Phone:860-917-0019
Practice Address - Fax:833-449-5031
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELCG MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site