Provider Demographics
NPI:1902995012
Name:ELKIN, WARREN (DPM PT)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:ELKIN
Suffix:
Gender:M
Credentials:DPM PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 WEST 5 ST
Mailing Address - Street 2:19C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224
Mailing Address - Country:US
Mailing Address - Phone:718-449-2236
Mailing Address - Fax:
Practice Address - Street 1:2790 WEST 5 ST
Practice Address - Street 2:19C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224
Practice Address - Country:US
Practice Address - Phone:718-449-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0030771213E00000X
NY4629225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T50983Medicare UPIN
P33702Medicare ID - Type Unspecified