Elisabeth Theophile

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

002586-P.A Issued in PR

Practice address

21 E Decatur Ave
Pleasantville, NJ 08232-3008

Phone

(973) 771-9268

NPI assigned

Aug 15, 2025

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1755216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755216000000",
    "number": "1790661502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 E DECATUR AVE",
            "city": "PLEASANTVILLE",
            "state": "NJ",
            "postal_code": "082323008",
            "telephone_number": "973-771-9268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 E DECATUR AVE",
            "city": "PLEASANTVILLE",
            "state": "NJ",
            "postal_code": "082323008",
            "telephone_number": "973-771-9268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEOPHILE",
        "first_name": "ELISABETH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-08-15",
        "last_updated": "2025-08-15",
        "certification_date": "2025-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PR",
            "license": "002586-P.A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Pleasantville, NJ
• Providers in Pleasantville, NJ by specialty
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.