Provider Demographics
NPI:1902417801
Name:ELMAN, MITCH (DIRECTOR)
Entity Type:Individual
Prefix:
First Name:MITCH
Middle Name:
Last Name:ELMAN
Suffix:
Gender:M
Credentials:DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 WHITE HORSE AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-1407
Mailing Address - Country:US
Mailing Address - Phone:609-581-8400
Mailing Address - Fax:609-581-8600
Practice Address - Street 1:941 WHITE HORSE AVE STE 20
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-1407
Practice Address - Country:US
Practice Address - Phone:609-581-8400
Practice Address - Fax:609-581-8600
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0057200251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health