Provider Demographics
NPI:1649362377
Name:VELLAS, ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:VELLAS
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 1:50 POMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2917
Mailing Address - Country:US
Mailing Address - Phone:201-896-0900
Mailing Address - Fax:201-896-2627
Practice Address - Street 1:50 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2917
Practice Address - Country:US
Practice Address - Phone:201-896-0900
Practice Address - Fax:201-896-2627
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA473252083X0100X
NJ25MA04732500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0K1348OtherHEALTHNET
NJ454367OtherRAIL ROAD MEDICARE
NJVE454367Medicare ID - Type Unspecified
NJ454367OtherRAIL ROAD MEDICARE