MEDICARE: ELIZABETH FOMENKY

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
1	104100000X	Social Worker	LG200004536	DC
2	374U00000X	Home Health Aide	HHA9534	DC

General Provider Information

NPI Number	:	1760819841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH FOMENKY

Provider Business Mailing Address
First Line	:	1818 NEW YORK AVE NE STE 203
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-1849
Country	:	US
Telephone Number	:	202-280-7630
Fax Number	:

Provider Business Practice Location Address
First Line	:	7600 GEORGIA AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20012-1616
Country	:	US
Telephone Number	:	202-723-3060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2013
Last Update Date	:	05/29/2026

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Directions to “ ELIZABETH FOMENKY ” Practice Location

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