Provider Demographics
NPI:1093794182
Name:ELASHKER, AMIN R (DO)
Entity Type:Individual
Prefix:
First Name:AMIN
Middle Name:R
Last Name:ELASHKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 MARYS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5849
Mailing Address - Country:US
Mailing Address - Phone:845-339-1515
Mailing Address - Fax:845-331-1996
Practice Address - Street 1:100 RESERVE RD STE A4
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5267
Practice Address - Country:US
Practice Address - Phone:203-794-1979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT76537207R00000X
NY197149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01821190Medicaid
NY197149OtherLICENSE
CT76537OtherLICENSE
G55655Medicare UPIN