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General NPI Number Information
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NPI Number | 1023841483
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Entity Type | Individual
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Provider Name | MRS. ELISHEVA PRIVALSKY
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Gender | Female
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Dates
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Enumeration Date | 08/21/2024
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 1201 RIVER AVE UNIT 10
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5676
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Country | US
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Telephone | 732-775-0222
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Fax | 732-775-0224
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Provider Business Mailing Address
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Address Line | 865 HWY 33 STE 3 UNIT # 130
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City | FREEHOLD
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State | NJ
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Zip | 07728
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Country | US
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Telephone | 732-908-8354
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | F06232148
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F06232148
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License Number State | NJ
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