MR. ELLIOT S FORMAL (NPI# 1649834656) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649834656 |
| Entity Type | Individual |
| Full Name | MR. ELLIOT S FORMAL |
| Credential | PA-C |
| Practice Address |
1265 Paterson Plank Rd Secaucus NJ 07094-3242 |
| Mailing Address |
42 Estaugh Ave Haddonfield NJ 08033-2506 |
| Practice Telephone | 2015522728 |
| Mailing Telephone | 6095023182 |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2019-04-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
25MP00503300 | PA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
MA060450 | NJ | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1265 PATERSON PLANK RD |
| City | SECAUCUS |
| State | NJ |
| Zip Code | 07094-3242 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073555918 | Michael A Ortiz | Specialist | 1265 Paterson Plank Rd, Secaucus, NJ 07094-3242 | 2006-06-12 |
| 1861099277 | Grace Tomko | Physician Assistant | 1265 Paterson Plank Rd, Secaucus, NJ 07094-3242 | 2020-10-08 |
| 1366088890 | Beyond Radix LLC | Physical Therapist | 1265 Paterson Plank Rd, Secaucus, NJ 07094-3242 | 2019-11-19 |
| 1235587379 | Medpro Healthcare PC | Family Medicine | 1265 Paterson Plank Rd, Suite 2d, Secaucus, NJ 07094-3242 | 2016-05-31 |
| 1427476043 | Meadowlands Cardiology PC | Specialist | 1265 Paterson Plank Rd, Secaucus, NJ 07094-3242 | 2014-04-01 |
| 1659707073 | Christina Degennaro | Physical Therapist | 1265 Paterson Plank Rd, Suite 2c, Secaucus, NJ 07094-3242 | 2013-09-17 |
| 1013192285 | Jennifer Andrea Duda | Dietitian, Registered | 1265 Paterson Plank Rd, Suite 3b, Secaucus, NJ 07094 | 2008-01-07 |
| 1801082136 | J S Moukdad Md LLC | Internal Medicine | 1265 Paterson Plank Rd, Suite 3 B, Secaucus, NJ 07094-3242 | 2007-09-20 |
| 1720278955 | Karen Mehegan | Physical Therapist | 1265 Paterson Plank Rd, Suite 2c, Secaucus, NJ 07094-3242 | 2007-07-25 |
| 1215140017 | George Tsirogiannis | Podiatrist | 1265 Paterson Plank Rd, Suite 3c, Secaucus, NJ 07094-3242 | 2007-05-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629626163 | Meadowlands Pharmacy LLC | Pharmacy | 40, Meadowlands Pkway, Secaucus, NJ 07094 | 2019-08-28 |
| 1639625916 | Monika Patel | Dentist | 87 Huber St, Secacus, NJ 07094 | 2016-08-28 |
| 1366830820 | Morgan & Associates | Allergy & Immunology | 400 Park Place, Secaucus, NJ 07094 | 2015-01-06 |
| 1619267697 | Maria Lourdes D. Aguilera | Clinic/Center | 5301 Broadway Avenue, West New York, NJ 07094 | 2011-04-12 |
| 1154626117 | Robert W. Boyajian, Md, Pa | Internal Medicine | 255 Route 3 East Suite 203, Secaucus, NJ 07094 | 2011-01-21 |
| 1902071731 | Joseph D. Scalia | Surgery | 714-10th Street, Secaucus, NJ 07094 | 2008-04-23 |
| 1477764884 | Atlantis Health and Wellness PC | Chiropractor | 600 Plaza Dr, Harmon Meadow Plaza, Secaucus, NJ 07094 | 2007-05-25 |
| 1265558589 | Occupational Health Centers of New Jersey, P.a. | Clinic/Center | 30 Seaview Drive, Secaucus, NJ 07094 | 2007-03-21 |
| 1699899666 | Armando Ivan Martinez | Orthopaedic Surgery | 405 County Avenue, Secaucus, NJ 07094 | 2007-03-16 |
| 1457498768 | Nimer M Iskandarani | Psychiatry & Neurology | 255 Rt 3 East, Suite 209, Secaucus, NJ 07094 | 2007-01-30 |
| Find all providers in zip 07094 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750740791 | Awisha Bansal | Physician Assistant | 30 Seaview Dr, Secaucus, NJ 07094-1826 | 2016-02-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891300612 | Heather C. Williamson | Physician Assistant | 57 Willis Dr, West Trenton, NJ 08628 | 2020-09-09 |
| 1427660810 | Lauren Colacicco | Physician Assistant | 406 Nj-23 North, Franklin, NJ 07416 | 2020-08-18 |
| 1912525353 | Thy T Pham | Physician Assistant | 2 Capital Way Ste 407, Pennington, NJ 08534-2521 | 2020-07-13 |
| 1982226270 | Alexandra Bellisario | Physician Assistant | 7 Normandy Pl, Colts Neck, NJ 07722-1174 | 2020-05-11 |
| 1497394266 | Trevor Paul | Physician Assistant | 167 Us Highway 9 Ste 5, Englishtown, NJ 07726-9215 | 2019-12-27 |
| 1295371003 | Sujin Kim | Physician Assistant | 500 Grand Ave Ste 201, Englewood, NJ 07631-4968 | 2019-11-27 |
| 1811531767 | Kaceyanne Lynn Cerankowski | Physician Assistant | 3131 Princeton Pike Bldg 4a, Lawrenceville, NJ 08648-2201 | 2019-11-04 |
| 1760024665 | Paula Kolodynski | Physician Assistant | 355 Us Route 22, Springfield Township, NJ 07081 | 2019-10-11 |
| 1245871334 | Terrell Amanda Collins | Physician Assistant | 76 W Jimmie Leeds Rd Ste 201, Galloway, NJ 08205-9417 | 2019-10-01 |
| 1013561422 | Adrienne Lauren Rinaldi | Physician Assistant | 1400 State Highway 70, Relievus, Cherry Hill, NJ 08034-0000 | 2019-07-25 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.