=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760497531
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANIEL A. ELBER, D.O., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2006
-----------------------------------------------------
Last Update Date | 01/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 JAMES ST SUITE 202
-----------------------------------------------------
City | EDISON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08820-3970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-548-5541
-----------------------------------------------------
Fax | 732-548-2610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 JAMES ST SUITE 202
-----------------------------------------------------
City | EDISON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08820-3970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-548-5541
-----------------------------------------------------
Fax | 732-548-2610
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE ADMINISTRATOR
-----------------------------------------------------
Name | SANDRA ELBER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-548-5541
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 25MB0153600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------