Healthcare Provider Details

I. General information

NPI: 1669193462
Provider Name (Legal Business Name): CATHERINE ELIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 07/04/2024
Certification Date: 07/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 PATERSON AVE STE 302
EAST RUTHERFORD NJ
07073-1841
US

IV. Provider business mailing address

196 PATERSON AVE STE 302
EAST RUTHERFORD NJ
07073-1841
US

V. Phone/Fax

Practice location:
  • Phone: 201-500-9450
  • Fax: 201-500-9451
Mailing address:
  • Phone: 201-500-9450
  • Fax: 201-500-9451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MP00747300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: