Healthcare Provider Details

I. General information

NPI: 1417241647
Provider Name (Legal Business Name): MARC J ELKOWITZ, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 NORTHERN BLVD SUITE 203
GREAT NECK NY
11021-4311
US

IV. Provider business mailing address

107 NORTHERN BLVD SUITE 203
GREAT NECK NY
11021-4311
US

V. Phone/Fax

Practice location:
  • Phone: 516-773-9200
  • Fax: 516-829-3565
Mailing address:
  • Phone: 516-773-9200
  • Fax: 516-829-3565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number206901
License Number StateNY

VIII. Authorized Official

Name: DR. MARC JEFFREY ELKOWITZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 516-773-9200