Healthcare Provider Details

I. General information

NPI: 1588647879
Provider Name (Legal Business Name): ELVIRA CALLAHAN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6259 108TH ST APT 1L
FOREST HILLS NY
11375-1307
US

IV. Provider business mailing address

6259 108TH ST APT 1L
FOREST HILLS NY
11375-1307
US

V. Phone/Fax

Practice location:
  • Phone: 718-275-7590
  • Fax: 718-313-3840
Mailing address:
  • Phone: 718-275-7590
  • Fax: 718-313-3840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberNY005404
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberNY005404
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberNY005404
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: