Provider Demographics
NPI:1609923317
Name:ELBAUM, JEFFREY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:ELBAUM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 TULIP CT
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1659
Mailing Address - Country:US
Mailing Address - Phone:732-229-5920
Mailing Address - Fax:
Practice Address - Street 1:1125 STATE ROUTE 35
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4043
Practice Address - Country:US
Practice Address - Phone:732-531-8700
Practice Address - Fax:732-531-8775
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0188551223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJEL777950Medicare ID - Type Unspecified
NJ059276Medicare UPIN