Provider Demographics
NPI:1275793507
Name:ELITSUR, NOEET (MD)
Entity Type:Individual
Prefix:DR
First Name:NOEET
Middle Name:
Last Name:ELITSUR
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:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:904-697-5062
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:2950 COLLEGE DR
Practice Address - Street 2:SUITE #2B - S. JERSEY HEALTHCARE BLDG
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6933
Practice Address - Country:US
Practice Address - Phone:856-309-8508
Practice Address - Fax:856-309-2714
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2015-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJMA097231002080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program