Provider Demographics
NPI:1679118392
Name:IGOR ELMAN PHYSICIAN PC
Entity type:Organization
Organization Name:IGOR ELMAN PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-607-4265
Mailing Address - Street 1:7 MEDICAL PARK DR # C
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3562
Mailing Address - Country:US
Mailing Address - Phone:845-362-1169
Mailing Address - Fax:845-362-0111
Practice Address - Street 1:7 MEDICAL PARK DR # C
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3562
Practice Address - Country:US
Practice Address - Phone:845-362-1169
Practice Address - Fax:845-362-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty