Individual provider Active NPI

Evangelos E Eleftheriou, PA-C

  • Medical Physician Assistant
  • Union, NJ
National Provider Identifier
1295143337
Registry record updated Jul 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
25MP00340000 Issued in NJ
Practice address
2317 Center Island Route 22
Union, NJ 07083
Phone
(201) 354-1951
Fax
(201) 354-1952
NPI assigned
Jul 31, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 25MP00340000 NJ
Medical Physician Assistant 363AM0700X 25MP00340000 NJ Primary

Addresses

Primary practice location

2317 Center Island Route 22
Union, NJ 07083

Mailing address

1 Diamond Hill Rd
Berkeley Heights, NJ 07922-2104
Phone (732) 726-0011

Other practice location 1

94 Old Short Hills Rd
Livingston, NJ 07039-5672
Phone (973) 322-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141008001625 NJ Practitioner - Physician Assistant 7315167665 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Medical Group PAGroup PAC ID 5395642276, 1,204 clinicians

Practice addresses (Care Compare)

1 Diamond Hill Rd
Berkeley Heights, NJ 07922-2104
Phone (908) 273-4300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
25MP00340000NJMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group PA CurrentSince Sep 21, 2020 Accepting new patients
Summit Medical Group PA CurrentSince Sep 21, 2020 Accepting new patients

Locations

1 Diamond Hill Rd
Berkeley Heights, NJ 07922
Phone (908) 277-8868

94 Old Short Hills Rd
#C
Livingston, NJ 07039

94 Old Short Hills Rd
Livingston, NJ 07039
Phone (973) 322-5400

Interoperability endpoints

  • Direct secure messaging: eeleftheriou45194@epicdirect.rwjbh.org
  • Direct secure messaging: evangelos.eleftheriou.1@2983.direct.athenahealth.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657497600000",
    "number": "1295143337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 DIAMOND HILL RD",
            "city": "BERKELEY HEIGHTS",
            "state": "NJ",
            "postal_code": "079222104",
            "telephone_number": "732-726-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2317 CENTER ISLAND ROUTE 22",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "07083",
            "telephone_number": "201-354-1951",
            "fax_number": "201-354-1952"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "94 Old Short Hills Rd",
            "address_purpose": "LOCATION",
            "city": "Livingston",
            "state": "NJ",
            "postal_code": "070395672",
            "country_code": "US",
            "telephone_number": "973-322-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELEFTHERIOU",
        "first_name": "EVANGELOS",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-31",
        "last_updated": "2022-07-11",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00340000",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NJ",
            "license": "25MP00340000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Union, NJ

Sources for this page

Verify at the official NPI Registry.