Individual
ELISSA ANN FAVATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1401 ROUTE 70 EAST, SUITE 14, SOUTH JERSEY MEDICAL CENTER, CHERRY HILL, NJ 08034
(856) 216-1100
(856) 216-0484
Mailing address
1401 ROUTE 70 EAST, SUITE 14, SOUTH JERSEY MEDICAL CENTER, CHERRY HILL, NJ 08034
(856) 216-1100
(856) 216-0484
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MA04036200
NJ
207R00000X
Internal Medicine Physician
C1-0004751
DE
207R00000X
Internal Medicine Physician
MD046205L
PA
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
Primary
25MA04036200
NJ
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
C1-0004751
DE
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
MD046205L
PA
Other
Enumeration date
12/14/2006
Last updated
07/11/2007
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