Provider Demographics
NPI:1790887412
Name:HERMOSILLA, ELIAS P (MD)
Entity Type:Individual
Prefix:MR
First Name:ELIAS
Middle Name:P
Last Name:HERMOSILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:95 HIDDEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1212
Mailing Address - Country:US
Mailing Address - Phone:732-821-2997
Mailing Address - Fax:732-821-2997
Practice Address - Street 1:110 REHILL AVE
Practice Address - Street 2:SOMERSET MED CENTER
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2598
Practice Address - Country:US
Practice Address - Phone:908-685-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02916700208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery