Provider Demographics
NPI:1962449207
Name:MOUSTAFELLOS, ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:MOUSTAFELLOS
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 1:155 POLIFLY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1758
Mailing Address - Country:US
Mailing Address - Phone:551-996-8840
Mailing Address - Fax:201-441-9949
Practice Address - Street 1:155 POLIFLY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1758
Practice Address - Country:US
Practice Address - Phone:551-996-8840
Practice Address - Fax:201-441-9949
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA072495002080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology