Provider Demographics
NPI:1710906888
Name:ELINOFF, VICTOR A (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:A
Last Name:ELINOFF
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 1:415 HOOPER RD
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-3698
Mailing Address - Country:US
Mailing Address - Phone:607-754-3863
Mailing Address - Fax:607-754-5697
Practice Address - Street 1:415 HOOPER ROAD
Practice Address - Street 2:ENDWELL FAMILY PHYSICIANS LLP
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-3698
Practice Address - Country:US
Practice Address - Phone:607-754-3863
Practice Address - Fax:607-754-5697
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124047207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
58139OtherGHI HMO
NY0043205OtherCHAMPUS
2325OtherBLUEPOINT
2325OtherEMPIRE BS
4210347OtherAETNA
2325OtherHMO BLUE
NY00557566Medicaid
2325OtherBS CNY
9682187OtherGHI
10031718OtherCDPHP
2325OtherEXCELLUS
878445OtherAETNA HMO
954147OtherMVP
954147OtherMVP SELECT
878445OtherAETNA HMO
38661CMedicare ID - Type Unspecified