Provider Demographics
NPI:1659491892
Name:ENERIO-ELLANT, DEVI G (DPM)
Entity Type:Individual
Prefix:
First Name:DEVI
Middle Name:G
Last Name:ENERIO-ELLANT
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 1:2 5TH AVE
Mailing Address - Street 2:APT 8U
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8856
Mailing Address - Country:US
Mailing Address - Phone:212-228-0879
Mailing Address - Fax:212-228-0879
Practice Address - Street 1:773-775 9TH AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-8856
Practice Address - Country:US
Practice Address - Phone:917-991-4168
Practice Address - Fax:212-228-0879
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005634213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY59C341Medicare ID - Type Unspecified
NYU79979Medicare UPIN