Provider Demographics
NPI:1760497531
Name:DANIEL A. ELBER, D.O., P.A.
Entity Type:Organization
Organization Name:DANIEL A. ELBER, D.O., P.A.
Other - Org Name:PREVENTIVE HEALTHCARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-548-5541
Mailing Address - Street 1:102 JAMES ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3970
Mailing Address - Country:US
Mailing Address - Phone:732-548-5541
Mailing Address - Fax:732-548-2610
Practice Address - Street 1:102 JAMES ST
Practice Address - Street 2:SUITE 202
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3970
Practice Address - Country:US
Practice Address - Phone:732-548-5541
Practice Address - Fax:732-548-2610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB0153600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2661403Medicaid
NJ2661403Medicaid