Provider Demographics
NPI:1952689853
Name:DR ELSIE WITT-BOCKLER, PHYSICIAN PC
Entity Type:Organization
Organization Name:DR ELSIE WITT-BOCKLER, PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WITT-BOCKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-671-0445
Mailing Address - Street 1:87 GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-1430
Mailing Address - Country:US
Mailing Address - Phone:516-671-0445
Mailing Address - Fax:516-759-7975
Practice Address - Street 1:87 GLEN AVE
Practice Address - Street 2:
Practice Address - City:SEA CLIFF
Practice Address - State:NY
Practice Address - Zip Code:11579-1430
Practice Address - Country:US
Practice Address - Phone:516-671-0445
Practice Address - Fax:516-759-7975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180772207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE69031Medicare UPIN