Provider Demographics
NPI:1730325325
Name:ELLIOT PROFESSIONAL SERVICES
Entity type:Organization
Organization Name:ELLIOT PROFESSIONAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS & FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-663-4904
Mailing Address - Street 1:20 CHAMBERS ROAD
Mailing Address - Street 2:ELLIOT PEDIATRIC SPECIALISTS
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-1826
Mailing Address - Country:US
Mailing Address - Phone:603-647-0052
Mailing Address - Fax:603-626-8016
Practice Address - Street 1:20 CHAMBERS ROAD
Practice Address - Street 2:ELLIOT PEDIATRIC SPECIALISTS
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-1826
Practice Address - Country:US
Practice Address - Phone:603-647-0052
Practice Address - Fax:603-626-8016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLIOT PROFESSIONAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-02
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE6661OtherMEDICARE GROUP