MEDICARE: DR. ELLIOT REGENBOGEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	171320	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659373058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLIOT REGENBOGEN M.D.

Provider Business Mailing Address
First Line	:	109 WILSON DR
Second Line	:
City	:	PORT JEFFERSON
State	:	NY
Zip	:	11777-2044
Country	:	US
Telephone Number	:	914-643-8276
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 FORT WASHINGTON AVE.
Second Line	:	HARKNESS PAVILION 7TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10032-1003
Country	:	US
Telephone Number	:	212-305-8555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	10/31/2018

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