Provider Demographics
NPI:1861493397
Name:ALICAKOS, ELAINE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:ALICAKOS
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 1:400 FRANKLIN TPKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3516
Mailing Address - Country:US
Mailing Address - Phone:201-818-9114
Mailing Address - Fax:201-934-8223
Practice Address - Street 1:400 FRANKLIN TPKE
Practice Address - Street 2:SUITE 202
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-3516
Practice Address - Country:US
Practice Address - Phone:201-818-9114
Practice Address - Fax:201-934-8223
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD001807213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT84916Medicare UPIN
NJ6038090001Medicare NSC
NJAL400483Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
NJ1427246354Medicare NSC