Provider Demographics
NPI:1902041783
Name:ELAN MEDICAL LLC
Entity Type:Organization
Organization Name:ELAN MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-522-3205
Mailing Address - Street 1:241 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-2316
Mailing Address - Country:US
Mailing Address - Phone:201-653-7450
Mailing Address - Fax:
Practice Address - Street 1:79 HUDSON ST STE 302A
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5641
Practice Address - Country:US
Practice Address - Phone:201-653-7450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06653300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty