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NPI Code Detail

MEDICARE: ELIN IMAS PA

MEDICARE: ELIN IMAS PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1528238714
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIN IMAS PA
Provider Business Mailing Address
First Line : 161 WASHINGTON ST
Second Line : EIGHT TOWER BRIDGE STE. 1400
City : CONSHOHOCKEN
State : PA
Zip : 19428-2083
Country : US
Telephone Number : 866-825-3227
Fax Number : 866-397-7399
Provider Business Practice Location Address
First Line : 4905 W TROPICANA AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-5077
Country : US
Telephone Number : 866-825-3227
Fax Number : 866-397-1399
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2008
Last Update Date : 03/04/2008

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Directions to “ ELIN IMAS PA” Practice Location

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