Provider Demographics
NPI:1700964723
Name:ELSEN, STEPHANIE M (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:ELSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARCIA
Other - Last Name:ELSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1402 NE 34TH ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4538
Mailing Address - Country:US
Mailing Address - Phone:585-743-7013
Mailing Address - Fax:
Practice Address - Street 1:2007 PALM BEACH LAKES BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6501
Practice Address - Country:US
Practice Address - Phone:561-420-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175064207P00000X, 207R00000X
FL142718207R00000X
FLME142718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01190927Medicaid
NYP00132274OtherRAILROAD MEDICARE
NY01190927Medicaid
NYP00132274OtherRAILROAD MEDICARE