Healthcare Provider Details

I. General information

NPI: 1427291780
Provider Name (Legal Business Name): ELENSA MEDICAL II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 BROADWAY 2ND FLOOR
PATERSON NJ
07514-1992
US

IV. Provider business mailing address

1085 FRANKLIN LAKES ROAD
FRANKLIN LAKES NJ
07417-1131
US

V. Phone/Fax

Practice location:
  • Phone: 973-977-8105
  • Fax: 973-977-8106
Mailing address:
  • Phone: 973-977-8105
  • Fax: 973-977-8106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number25MA07696900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number25MA07696900
License Number StateNJ

VIII. Authorized Official

Name: DR. BENJAMIN ANTONIO SABIDO
Title or Position: OWNER
Credential: M.D.
Phone: 973-977-8105