| Elangovan Psychiatric Services Llc | |
|
470 Prospect Ave Ste 202 West Orange NJ 07052-4106 | |
| (973) 325-5100 | |
| (973) 488-7133 |
| Full Name | Elangovan Psychiatric Services Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 470 Prospect Ave Ste 202, West Orange, New Jersey |
| Authorized Official Name and Position | Judy Gerdts (OFFICE MANAGER) |
| Authorized Official Contact | 7184775670 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elangovan Psychiatric Services Llc 1756 Richmond Ave Staten Island NY 10314-3902 Ph: (718) 477-5670 | Elangovan Psychiatric Services Llc 470 Prospect Ave Ste 202 West Orange NJ 07052-4106 Ph: (973) 325-5100 |
| NPI Number | 1619623071 |
|---|---|
| Provider Enumeration Date | 02/24/2022 |
| Last Update Date | 02/24/2022 |
| Certification Date | 02/24/2022 |
| Medicare PECOS PAC ID | 8729460894 |
|---|---|
| Medicare Enrollment ID | O20220805001665 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619623071 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Natarajan Elangovan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649203530 PECOS PAC ID: 9133134562 Enrollment ID: I20111020000027 |
| Provider Name | Elda Ziko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639580301 PECOS PAC ID: 0941585152 Enrollment ID: I20170329002554 |
| Provider Name | Shashi Elangovan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356462246 PECOS PAC ID: 6406124510 Enrollment ID: I20200413002645 |
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