Organization
ELLIOT PROFESSIONAL SERVICES
Active
Parent organization
ELLIOT PROFESSIONAL SERVICES
Other names
NICU Follow Up Program
Organization subpart
Yes
Provider details
NPI number
Legal business name
ELLIOT PROFESSIONAL SERVICES
Authorized official
RICHARD P. HERMAN (DIRECTOR OF OPERATIONS AND FINANCE)
(603) 663-4904
Entity
Organization
Contact information
Practice address
275 MAMMOTH RD, SUITE 1C, MANCHESTER, NH 03109-4133
(603) 663-4539
(603) 663-3982
Mailing address
275 MAMMOTH RD, SUITE 1C, MANCHESTER, NH 03109-4133
(603) 663-4539
(603) 663-3982
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RE6661
MEDICARE GROUP
NH
Enumeration date
06/22/2010
Last updated
06/22/2010
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