Provider Demographics
NPI:1215378369
Name:GOLDWASER, ELAN LURIA (DO)
Entity Type:Individual
Prefix:
First Name:ELAN
Middle Name:LURIA
Last Name:GOLDWASER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:622 W 168TH ST PH 11
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:212-305-9137
Mailing Address - Fax:212-304-7050
Practice Address - Street 1:693 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10709
Practice Address - Country:US
Practice Address - Phone:914-787-3292
Practice Address - Fax:212-304-7050
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289782207QS0010X
PAOT017262207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty