Provider Demographics
NPI:1710120944
Name:CONG, ELAINE ALICE (MD)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:ALICE
Last Name:CONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 ENGLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2507
Mailing Address - Country:US
Mailing Address - Phone:201-567-2050
Mailing Address - Fax:201-567-5070
Practice Address - Street 1:180 ENGLE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2507
Practice Address - Country:US
Practice Address - Phone:201-567-2050
Practice Address - Fax:201-567-5070
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09678600207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism