Provider Demographics
NPI:1710959945
Name:WILLIAMS, ELAINE R (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:255 ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:HENRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18332-7103
Mailing Address - Country:US
Mailing Address - Phone:718-644-2495
Mailing Address - Fax:347-329-0688
Practice Address - Street 1:800 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3003
Practice Address - Country:US
Practice Address - Phone:718-644-2495
Practice Address - Fax:347-329-0688
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005937213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02637603Medicaid
NYPH6301Medicare PIN
NYU95464Medicare UPIN