Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 030931 | CT |
Y | 207RP1001X | Pulmonary Disease | 030931 | CT |
NPI | 1053394114 |
---|---|
Provider Name | Jack A Elias |
First Address | New Haven, CT 06511-6624 |
Second Address | New Haven, CT 06519-1304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 01/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001309310 | (05) | CT |
C29873 | (02) |