Provider Demographics
NPI:1043767775
Name:ELISE E. ORZECK, D.P.M. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ELISE E. ORZECK, D.P.M. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORZECK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-346-8568
Mailing Address - Street 1:22035 ALIZONDO DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-4902
Mailing Address - Country:US
Mailing Address - Phone:818-346-8568
Mailing Address - Fax:818-704-7894
Practice Address - Street 1:22035 ALIZONDO DR
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-4902
Practice Address - Country:US
Practice Address - Phone:818-346-8568
Practice Address - Fax:818-704-7894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-11
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3923251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU51017Medicare UPIN