Provider Demographics
NPI:1164472023
Name:HARROP, ELYSE HORN (MD)
Entity Type:Individual
Prefix:MRS
First Name:ELYSE
Middle Name:HORN
Last Name:HARROP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 STOKES RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2913
Mailing Address - Country:US
Mailing Address - Phone:609-953-0908
Mailing Address - Fax:609-953-5978
Practice Address - Street 1:622 STOKES RD
Practice Address - Street 2:SUITE A
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2913
Practice Address - Country:US
Practice Address - Phone:609-953-0908
Practice Address - Fax:609-953-5978
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0682880207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G99630Medicare UPIN
029137PY3Medicare ID - Type Unspecified