Provider Demographics
NPI:1780607168
Name:ELLIOTT BILOFSKY DO PC
Entity type:Organization
Organization Name:ELLIOTT BILOFSKY DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:JODY
Authorized Official - Last Name:BILOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-623-6400
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006511L207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA109079Medicare PIN