Provider Demographics
NPI:1982662540
Name:BILOFSKY, ELLIOTT JODY (DO)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:JODY
Last Name:BILOFSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537
Mailing Address - Country:US
Mailing Address - Phone:814-623-6400
Mailing Address - Fax:814-623-1963
Practice Address - Street 1:202 MEMORIAL DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537
Practice Address - Country:US
Practice Address - Phone:814-623-6400
Practice Address - Fax:814-623-1963
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006511L207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011621390006Medicaid
F46517Medicare UPIN
PA0011621390006Medicaid