Provider Demographics
NPI:1104034578
Name:ELIA, HARRY R (DC)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:R
Last Name:ELIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1817
Mailing Address - Country:US
Mailing Address - Phone:201-599-0881
Mailing Address - Fax:201-599-0883
Practice Address - Street 1:41 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1817
Practice Address - Country:US
Practice Address - Phone:201-599-0881
Practice Address - Fax:201-599-0883
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00253400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJEL454609Medicare PIN