Provider Demographics
NPI:1518915040
Name:SALZHAUER, ELAN W (MD)
Entity Type:Individual
Prefix:
First Name:ELAN
Middle Name:W
Last Name:SALZHAUER
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 1:1226 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1155
Mailing Address - Country:US
Mailing Address - Phone:315-478-4185
Mailing Address - Fax:315-478-0840
Practice Address - Street 1:5100 W TAFT RD
Practice Address - Street 2:SUITE 4-D
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:315-458-6669
Practice Address - Fax:316-458-0819
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY238274208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02754561Medicaid
RB0475Medicare PIN
NY02754561Medicaid