Provider Demographics
NPI:1942305313
Name:BARENGOLTS, ELENA I
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:I
Last Name:BARENGOLTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4442
Mailing Address - Country:US
Mailing Address - Phone:626-282-0282
Mailing Address - Fax:626-282-0939
Practice Address - Street 1:3365 N ARLINGTON HEIGHTS RD STE K
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7700
Practice Address - Country:US
Practice Address - Phone:847-870-1702
Practice Address - Fax:847-870-1701
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC134217207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
P13629Medicare UPIN
C43326Medicare ID - Type Unspecified