Provider Demographics
NPI:1659538544
Name:ELLIOTT D ENGEL, DPM
Entity Type:Organization
Organization Name:ELLIOTT D ENGEL, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-443-5709
Mailing Address - Street 1:406 NORRISTOWN RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-1250
Mailing Address - Country:US
Mailing Address - Phone:215-443-5709
Mailing Address - Fax:215-443-5716
Practice Address - Street 1:406 NORRISTOWN RD
Practice Address - Street 2:SUITE F
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-1250
Practice Address - Country:US
Practice Address - Phone:215-443-5709
Practice Address - Fax:215-443-5716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002302L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033486Medicaid
PAT30135Medicare PIN
PAEN199048Medicare PIN