Healthcare Provider Details

I. General information

NPI: 1710721931
Provider Name (Legal Business Name): ELISABETH WOOD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 PACIFIC AVE
ATLANTIC CITY NJ
08401-6713
US

IV. Provider business mailing address

1925 PACIFIC AVE
ATLANTIC CITY NJ
08401-6713
US

V. Phone/Fax

Practice location:
  • Phone: 609-441-8165
  • Fax: 609-593-9850
Mailing address:
  • Phone: 609-441-8165
  • Fax: 609-593-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00969400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: