Provider Demographics
NPI:1477623882
Name:ARTEAGA, ELMER CESAR (MD)
Entity Type:Individual
Prefix:
First Name:ELMER
Middle Name:CESAR
Last Name:ARTEAGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 GRAND CONCOURSE AVE
Mailing Address - Street 2:SUITE 2M
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1226
Mailing Address - Country:US
Mailing Address - Phone:718-220-4442
Mailing Address - Fax:718-220-4546
Practice Address - Street 1:3201 GRAND CONCOURSE AVE
Practice Address - Street 2:SUITE 2M
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1226
Practice Address - Country:US
Practice Address - Phone:718-220-4442
Practice Address - Fax:718-220-4546
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192323208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01567537Medicaid