Provider Demographics
NPI:1619064938
Name:ELDERPATH MEDICAL, PC
Entity Type:Organization
Organization Name:ELDERPATH MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PUNEET
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:SAWHNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:201-689-0604
Mailing Address - Street 1:306 BLAUVELT CT
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1763
Mailing Address - Country:US
Mailing Address - Phone:201-689-0604
Mailing Address - Fax:201-786-9080
Practice Address - Street 1:306 BLAUVELT CT
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1763
Practice Address - Country:US
Practice Address - Phone:201-689-0604
Practice Address - Fax:201-786-9080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210130207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW86521Medicare ID - Type Unspecified