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NPI Code Detail

MEDICARE: MARLENA ELAZAR

MEDICARE: MARLENA ELAZAR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant012713NY
2363AM0700XMedical Physician Assistant25MP00701700NJ

General Provider Information

NPI Number : 1790932333
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARLENA ELAZAR
Provider Business Mailing Address
First Line : 1 DIAMOND HILL RD
Second Line :
City : BERKELEY HEIGHTS
State : NJ
Zip : 07922-2104
Country : US
Telephone Number : 908-273-4300
Fax Number :
Provider Business Practice Location Address
First Line : 852 ROUTE 3
Second Line :
City : CLIFTON
State : NJ
Zip : 07012-2343
Country : US
Telephone Number : 973-450-1991
Fax Number : 973-528-8009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2008
Last Update Date : 11/13/2024

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Directions to “ MARLENA ELAZAR ” Practice Location

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