Provider Demographics
NPI:1609028190
Name:ELIAV, ELI (DMD)
Entity Type:Individual
Prefix:PROF
First Name:ELI
Middle Name:
Last Name:ELIAV
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BERGEN ST
Mailing Address - Street 2:DEPARTMENT OF DIAGNOSTIC SCIENCES, PO BOX 1709
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2495
Mailing Address - Country:US
Mailing Address - Phone:973-972-8251
Mailing Address - Fax:973-972-3164
Practice Address - Street 1:110 BERGEN ST
Practice Address - Street 2:UMDNJ, NJDS, DEPARTMENT OF DIAGNOSTIC SCIENCES, D 860
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2495
Practice Address - Country:US
Practice Address - Phone:973-972-8251
Practice Address - Fax:973-972-3164
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ01599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist