Healthcare Provider Details

I. General information

NPI: 1609022599
Provider Name (Legal Business Name): ELIZABETH MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 MORRIS AVE 1ST FLOOR
ELIZABETH NJ
07208-1967
US

IV. Provider business mailing address

469 MORRIS AVE 1ST FLOOR
ELIZABETH NJ
07208-1967
US

V. Phone/Fax

Practice location:
  • Phone: 908-351-3535
  • Fax: 908-351-0161
Mailing address:
  • Phone: 908-351-3535
  • Fax: 908-351-0161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number073645
License Number StateNJ

VIII. Authorized Official

Name: DR. ELENA DRAGUN
Title or Position: MD
Credential: MD
Phone: 908-351-3535