Provider Demographics
NPI:1811955099
Name:ANTHONY EMELIANCHIK DPM PA
Entity type:Organization
Organization Name:ANTHONY EMELIANCHIK DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:EMELIANCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-589-4601
Mailing Address - Street 1:2051 PREVATT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6141
Mailing Address - Country:US
Mailing Address - Phone:352-589-4601
Mailing Address - Fax:352-589-1998
Practice Address - Street 1:2051 PREVATT ST
Practice Address - Street 2:SUITE B
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6141
Practice Address - Country:US
Practice Address - Phone:352-589-4601
Practice Address - Fax:352-589-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2285213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9868Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER N
FL6047150001Medicare NSC