Provider Demographics
NPI:1992878334
Name:MONTOURIS, ELAINE ALEXIS (MD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:ALEXIS
Last Name:MONTOURIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:136 SMOKE RISE DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-6821
Mailing Address - Country:US
Mailing Address - Phone:908-581-5668
Mailing Address - Fax:732-271-5853
Practice Address - Street 1:136 SMOKE RISE DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-6821
Practice Address - Country:US
Practice Address - Phone:908-581-5668
Practice Address - Fax:732-271-5853
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA00071469207R00000X
PAMD052220L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine