Provider Demographics
NPI:1669530499
Name:MAGIDS, ELI (DPM)
Entity type:Individual
Prefix:
First Name:ELI
Middle Name:
Last Name:MAGIDS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 LYDIA LN
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5323
Mailing Address - Country:US
Mailing Address - Phone:516-780-4865
Mailing Address - Fax:
Practice Address - Street 1:3201 LYDIA LN
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5323
Practice Address - Country:US
Practice Address - Phone:516-780-4865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004573213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY65757Medicare ID - Type Unspecified
NYUO6477Medicare UPIN