Provider Demographics
NPI:1124836135
Name:DEMOSTHENES, ELISHAMA
Entity type:Individual
Prefix:
First Name:ELISHAMA
Middle Name:
Last Name:DEMOSTHENES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELISHAMA
Other - Middle Name:
Other - Last Name:DEMOSTHENES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NON MEDICAL TRANSPOR
Mailing Address - Street 1:2600 TILTON RD # 1089
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-1831
Mailing Address - Country:US
Mailing Address - Phone:609-966-9322
Mailing Address - Fax:
Practice Address - Street 1:2600 TILTON RD # 1089
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-1831
Practice Address - Country:US
Practice Address - Phone:609-966-9322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-21
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver