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General NPI Number Information
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NPI Number | 1871742387
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Entity Type | Organization
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Legal Business Name | ELM MEDICAL, PC
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | 1723 ELM AVE
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City | BROOKLYN
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State | NY
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Zip | 11230-5306
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Country | US
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Telephone | 718-253-3322
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Fax | 718-258-6494
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Provider Business Mailing Address
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Address Line | 1723 ELM AVE
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City | BROOKLYN
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State | NY
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Zip | 11230-5306
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Country | US
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Telephone | 718-253-3322
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Fax | 718-258-6494
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GORDON CHARLES DAVIS
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Credential | D.O.
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Telephone | 718-253-3322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 171745-1
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 171745-1
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License Number State | NY
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