Basic Information
| Provider Information | |||||||||
| NPI: | 1235386582 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALT | ||||||||
| FirstName: | ELAINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 CHADWICK RD | ||||||||
| Address2: | |||||||||
| City: | TEANECK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076664252 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 MALCOLM AVE | ||||||||
| Address2: | QUEST DIAGNOSTICS | ||||||||
| City: | TETERBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076081011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013935294 | ||||||||
| FaxNumber: | 2014624712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2008 | ||||||||
| LastUpdateDate: | 08/10/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | ME79556 | FL | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0101X | 177340-1 | NY | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0101X | MD429640 | PA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0101X | 25MA05856900 | NJ | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
No ID Information.