Provider Demographics
NPI:1356387922
Name:BOVER, ELINA (DPM)
Entity type:Individual
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First Name:ELINA
Middle Name:
Last Name:BOVER
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Gender:F
Credentials:DPM
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Mailing Address - Street 1:2417 JERICHO TPKE
Mailing Address - Street 2:#355
Mailing Address - City:GARDEN CITY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4710
Mailing Address - Country:US
Mailing Address - Phone:718-830-3239
Mailing Address - Fax:718-830-3839
Practice Address - Street 1:9876 QUEENS BLVD
Practice Address - Street 2:SUITE1C
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4398
Practice Address - Country:US
Practice Address - Phone:718-830-3239
Practice Address - Fax:718-830-3839
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
NYN005731213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB8067969OtherDEA
NYU94615Medicare UPIN
NYG400082419Medicare UPIN