Healthcare Provider Details

I. General information

NPI: 1235156969
Provider Name (Legal Business Name): ELIOT HOWARD CHODOSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 ROUTE 23 STE 300
WAYNE NJ
07470-7520
US

IV. Provider business mailing address

1680 ROUTE 23 STE 300
WAYNE NJ
07470-7520
US

V. Phone/Fax

Practice location:
  • Phone: 973-942-4778
  • Fax: 973-942-7020
Mailing address:
  • Phone: 973-942-4778
  • Fax: 973-942-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA04293200
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier1920707
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: