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General NPI Number Information
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NPI Number | 1952764862
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Entity Type | Organization
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Legal Business Name | ELYSIUM AESTHETICS AND VEIN CARE, INC
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 06/03/2016
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Provider Practice Location Address
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Address Line | 400 STATE ROUTE 17
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City | RIDGEWOOD
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State | NJ
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Zip | 07450
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Country | US
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Telephone | 518-852-8114
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Fax | 866-339-2822
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Provider Business Mailing Address
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Address Line | 184 BEECHWOOD RD
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City | ORADELL
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State | NJ
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Zip | 07649
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Country | US
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Telephone | 518-852-8114
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Fax | 866-339-2822
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID SINGH
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Credential | MD
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Telephone | 518-852-8114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 25MA08769000
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License Number State | NJ
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