Provider Demographics
NPI:1295817955
Name:WILK, ELAINE LOMBARDI (DO)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:LOMBARDI
Last Name:WILK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:LOMBARDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1462 ERIE BLVD
Mailing Address - Street 2:ATTN: THE MEDICAL GROUP
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1026
Mailing Address - Country:US
Mailing Address - Phone:518-243-1020
Mailing Address - Fax:518-243-1021
Practice Address - Street 1:1101 NOTT ST
Practice Address - Street 2:DEPARTMENT OF EMERGENCY
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2425
Practice Address - Country:US
Practice Address - Phone:518-243-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179150-1207P00000X
RIDO00812207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01326874Medicaid
NY01326874Medicaid