Provider Demographics
NPI:1003141276
Name:E. TWENTE, MD, PC
Entity Type:Organization
Organization Name:E. TWENTE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:
Authorized Official - Last Name:TWENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-622-5796
Mailing Address - Street 1:45 PLAZA ST W
Mailing Address - Street 2:APT 2-B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3952
Mailing Address - Country:US
Mailing Address - Phone:718-622-5796
Mailing Address - Fax:
Practice Address - Street 1:45 PLAZA ST W
Practice Address - Street 2:APT 2-B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3952
Practice Address - Country:US
Practice Address - Phone:718-622-5796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0855482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00131228Medicaid
NY00131228Medicaid