Provider Demographics
NPI:1073941274
Name:ALTEMA, ELSIE
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:
Last Name:ALTEMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:973-656-6280
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:435 SOUTH ST
Practice Address - Street 2:SUITE 330
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6422
Practice Address - Country:US
Practice Address - Phone:973-971-7166
Practice Address - Fax:973-290-7518
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00456100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health