Provider Demographics
NPI:1770507949
Name:ELIAS, NIVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:NIVIN
Middle Name:
Last Name:ELIAS
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 1:3 RUBINO RD
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-8033
Mailing Address - Country:US
Mailing Address - Phone:973-882-8881
Mailing Address - Fax:
Practice Address - Street 1:1610 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-1924
Practice Address - Country:US
Practice Address - Phone:201-863-5696
Practice Address - Fax:201-863-5612
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08125500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine