Provider Demographics
NPI:1700921251
Name:ELTRA LLC
Entity type:Organization
Organization Name:ELTRA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:NEIGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-301-0500
Mailing Address - Street 1:254 COLUMBIA TPKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1237
Mailing Address - Country:US
Mailing Address - Phone:973-301-0500
Mailing Address - Fax:973-301-0501
Practice Address - Street 1:254 COLUMBIA TPKE
Practice Address - Street 2:SUITE 100
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1237
Practice Address - Country:US
Practice Address - Phone:973-301-0500
Practice Address - Fax:973-301-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04094400261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53755Medicare UPIN
NJ122135Medicare PIN