Provider Demographics
NPI:1609022599
Name:ELIZABETH MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:ELIZABETH MEDICAL ASSOCIATES LLC
Other - Org Name:ELENA DRAGUN MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAGUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-351-3535
Mailing Address - Street 1:469 MORRIS AVE 1ST FLOOR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1967
Mailing Address - Country:US
Mailing Address - Phone:908-351-3535
Mailing Address - Fax:908-351-0161
Practice Address - Street 1:469 MORRIS AVE 1ST FLOOR
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1967
Practice Address - Country:US
Practice Address - Phone:908-351-3535
Practice Address - Fax:908-351-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ073645207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ067629Medicare UPIN