Healthcare Provider Details

I. General information

NPI: 1861415366
Provider Name (Legal Business Name): ELENA K WELLENS D.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 CHESTNUT ST
PHILADELPHIA PA
19107-4216
US

IV. Provider business mailing address

833 CHESTNUT ST STE 520
PHILADELPHIA PA
19107-4430
US

V. Phone/Fax

Practice location:
  • Phone: 267-339-3558
  • Fax: 267-339-3763
Mailing address:
  • Phone: 800-321-9999
  • Fax: 267-339-3763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00274600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC004754L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number25MD00274600
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00274600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: