Provider Demographics
NPI:1932713955
Name:ELDER EXCELLENCE L.L.C.
Entity Type:Organization
Organization Name:ELDER EXCELLENCE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNILEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRINIDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-487-1962
Mailing Address - Street 1:101 N GROVE ST
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-4712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 N GROVE ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-4712
Practice Address - Country:US
Practice Address - Phone:908-487-1962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty