Provider Demographics
NPI:1588647879
Name:CALLAHAN, ELVIRA (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELVIRA
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10230 67TH AVE
Mailing Address - Street 2:SUITE 1S
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2455
Mailing Address - Country:US
Mailing Address - Phone:718-275-7590
Mailing Address - Fax:718-275-2582
Practice Address - Street 1:10230 67TH AVE
Practice Address - Street 2:SUITE 1S
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2455
Practice Address - Country:US
Practice Address - Phone:718-275-7590
Practice Address - Fax:718-275-2582
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY005404213EP1101X, 213ES0000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02043194Medicaid
NY4895450001OtherMEDICARE DME
NY4895450001OtherMEDICARE DME
NYPB6601Medicare PIN