Provider Demographics
NPI:1942618665
Name:ELENA ALTSHULER
Entity Type:Organization
Organization Name:ELENA ALTSHULER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTSHULER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-683-7773
Mailing Address - Street 1:256 BUNN DR STE 3A
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2859
Mailing Address - Country:US
Mailing Address - Phone:609-683-7773
Mailing Address - Fax:609-683-7958
Practice Address - Street 1:256 BUNN DR STE 3A
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2859
Practice Address - Country:US
Practice Address - Phone:609-683-7773
Practice Address - Fax:609-683-7958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06478800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty