Provider Demographics
NPI:1740264308
Name:ELSANT, MARTIN
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:ELSANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 AVE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:718-332-0545
Mailing Address - Fax:718-332-4209
Practice Address - Street 1:2021 AVE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-332-0545
Practice Address - Fax:718-332-4209
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14479412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00922349Medicaid
12F671Medicare ID - Type Unspecified
D91686Medicare UPIN