Provider Demographics
NPI:1265429781
Name:JAUREGUI, ELENA R (MD)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:R
Last Name:JAUREGUI
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 1:609 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1711
Mailing Address - Country:US
Mailing Address - Phone:908-351-1700
Mailing Address - Fax:908-351-2323
Practice Address - Street 1:609 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1711
Practice Address - Country:US
Practice Address - Phone:908-351-1700
Practice Address - Fax:908-351-2323
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61659207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6708005Medicaid
NJ959494Medicare ID - Type Unspecified
959494Medicare PIN
NJ6708005Medicaid