Healthcare Provider Details

I. General information

NPI: 1417191818
Provider Name (Legal Business Name): ELDERPATH MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 BLAUVELT CT
PARAMUS NJ
07652-1763
US

IV. Provider business mailing address

306 BLAUVELT CT
PARAMUS NJ
07652-1763
US

V. Phone/Fax

Practice location:
  • Phone: 201-689-0604
  • Fax: 973-750-3647
Mailing address:
  • Phone: 201-689-0604
  • Fax: 973-750-3647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number25MA06458400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JATINDER SINGH SAWHNEY
Title or Position: PRINCIPAL
Credential: MD
Phone: 201-689-0604