Provider Demographics
NPI:1548087844
Name:ELITE CONCIERGE MEDICINE LLC
Entity type:Organization
Organization Name:ELITE CONCIERGE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUX-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-736-1365
Mailing Address - Street 1:414 EAGLE ROCK AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4229
Mailing Address - Country:US
Mailing Address - Phone:973-736-1365
Mailing Address - Fax:973-736-1366
Practice Address - Street 1:5 ELM COURT WAY
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4927
Practice Address - Country:US
Practice Address - Phone:973-736-1365
Practice Address - Fax:973-736-1366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty