Provider Demographics
NPI:1548781461
Name:ELEMENTAL FAMILY HEALTH NP RN PC
Entity Type:Organization
Organization Name:ELEMENTAL FAMILY HEALTH NP RN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:JOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:973-570-6019
Mailing Address - Street 1:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:PINE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10969-0591
Mailing Address - Country:US
Mailing Address - Phone:973-570-6019
Mailing Address - Fax:
Practice Address - Street 1:68 HARRIS BUSHVILLE RD
Practice Address - Street 2:
Practice Address - City:HARRIS
Practice Address - State:NY
Practice Address - Zip Code:12742-1274
Practice Address - Country:US
Practice Address - Phone:973-570-6019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340764-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1417048166Medicaid