Provider Demographics
NPI:1144245416
Name:FOSTER, ELLIOT (DC)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:
Last Name:FOSTER
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 1:186 PATERSON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1837
Mailing Address - Country:US
Mailing Address - Phone:201-933-3040
Mailing Address - Fax:201-933-8611
Practice Address - Street 1:186 PATERSON AVE
Practice Address - Street 2:
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-1837
Practice Address - Country:US
Practice Address - Phone:201-933-3040
Practice Address - Fax:201-933-8611
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU59955Medicare UPIN
NJ461501NNYMedicare PIN