Healthcare Provider Details

I. General information

NPI: 1265429781
Provider Name (Legal Business Name): ELENA R JAUREGUI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 MORRIS AVE
ELIZABETH NJ
07208-1711
US

IV. Provider business mailing address

609 MORRIS AVE
ELIZABETH NJ
07208-1711
US

V. Phone/Fax

Practice location:
  • Phone: 908-351-1700
  • Fax: 908-351-2323
Mailing address:
  • Phone: 908-351-1700
  • Fax: 908-351-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA61659
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA61659
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: