Provider Demographics
NPI:1477831634
Name:DUNOFF-ROMERO, ELLIOT LUIS (PA-C)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:LUIS
Last Name:DUNOFF-ROMERO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:ELLIOT
Other - Middle Name:LUIS
Other - Last Name:ROMERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:1995 N PARK PL SE STE 550
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2228
Mailing Address - Country:US
Mailing Address - Phone:770-438-6318
Mailing Address - Fax:
Practice Address - Street 1:1995 N PARK PL SE STE 550
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2228
Practice Address - Country:US
Practice Address - Phone:770-438-6318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2018-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00260500363A00000X
GA8328363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant