Healthcare Provider Details

I. General information

NPI: 1760819841
Provider Name (Legal Business Name): ELIZABETH FOMENKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 GEORGIA AVE NW
WASHINGTON DC
20012-1616
US

IV. Provider business mailing address

1818 NEW YORK AVE NE STE 203
WASHINGTON DC
20002-1849
US

V. Phone/Fax

Practice location:
  • Phone: 202-723-3060
  • Fax:
Mailing address:
  • Phone: 202-280-7630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG200004536
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA9534
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: