Healthcare Provider Details

I. General information

NPI: 1598712861
Provider Name (Legal Business Name): ELIS M DE PRIORI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIS M DE PRIORI MD

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 LAUREL HEIGHTS DR
BRIDGETON NJ
08302-3635
US

IV. Provider business mailing address

215 LAUREL HEIGHTS DR
BRIDGETON NJ
08302-3635
US

V. Phone/Fax

Practice location:
  • Phone: 856-455-6002
  • Fax: 856-455-6106
Mailing address:
  • Phone: 856-455-6002
  • Fax: 856-455-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25MA0046556
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: