Provider Demographics
NPI:1356368971
Name:DENNIS, ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PIERRO
Other - Middle Name:
Other - Last Name:CHRISTIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17 CASINO DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-3701
Mailing Address - Country:US
Mailing Address - Phone:732-938-3580
Mailing Address - Fax:
Practice Address - Street 1:4013 ROUTE 9 N
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-4021
Practice Address - Country:US
Practice Address - Phone:732-905-5255
Practice Address - Fax:732-905-5266
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 423829207P00000X
NJ25MA07164700207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10110345Medicaid
H44571Medicare UPIN
PA10110345Medicaid
NJ049862NYNMedicare PIN