Provider Demographics
NPI:1780975953
Name:ELLIOT PROFESSIONAL SERVICES
Entity type:Organization
Organization Name:ELLIOT PROFESSIONAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS & FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-663-4904
Mailing Address - Street 1:15 NELSON ST FL 2
Mailing Address - Street 2:ELLIOT OBSTETRICS AND GYNECOLOGY
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-2706
Mailing Address - Country:US
Mailing Address - Phone:603-624-8491
Mailing Address - Fax:603-625-1622
Practice Address - Street 1:15 NELSON ST FL 2
Practice Address - Street 2:ELLIOT OBSTETRICS AND GYNECOLOGY
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2706
Practice Address - Country:US
Practice Address - Phone:603-624-8491
Practice Address - Fax:603-625-1622
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLIOT PROFESSIONAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty