Provider Demographics
NPI:1982182051
Name:ELLIOTT, STORY (DO)
Entity Type:Individual
Prefix:
First Name:STORY
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-2482
Mailing Address - Country:US
Mailing Address - Phone:973-227-0020
Mailing Address - Fax:973-808-3320
Practice Address - Street 1:150 FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2482
Practice Address - Country:US
Practice Address - Phone:973-227-0020
Practice Address - Fax:973-808-3320
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11213900207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine