Provider Demographics
NPI:1336117068
Name:ELKOWITZ, SHERYL SUE (MD)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:SUE
Last Name:ELKOWITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2598
Mailing Address - Country:US
Mailing Address - Phone:631-930-9422
Mailing Address - Fax:631-930-9451
Practice Address - Street 1:150 E SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2598
Practice Address - Country:US
Practice Address - Phone:631-930-9422
Practice Address - Fax:631-930-9451
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1710702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1SS00169Medicaid
NY1SS00169Medicaid
NY06J351Medicare ID - Type Unspecified