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NPI Code Detail

MEDICARE: ELLIOT J PELLMAN MD

MEDICARE: ELLIOT J PELLMAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RS0010XSports Medicine (Internal Medicine) Physician144088NY

General Provider Information

NPI Number : 1235192998
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLIOT J PELLMAN MD
Provider Business Mailing Address
First Line : 2800 MARCUS AVE
Second Line :
City : LAKE SUCCESS
State : NY
Zip : 11042-1008
Country : US
Telephone Number : 516-622-6040
Fax Number :
Provider Business Practice Location Address
First Line : 2800 MARCUS AVE
Second Line :
City : LAKE SUCCESS
State : NY
Zip : 11042-1008
Country : US
Telephone Number : 516-622-6040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2006
Last Update Date : 07/08/2007

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