MEDICARE: DR. ELAINE ALICAKOS DPM

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	213ES0131X	Foot Surgery Podiatrist	MD001807	NJ

General Provider Information

NPI Number	:	1861493397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELAINE ALICAKOS DPM

Provider Business Mailing Address
First Line	:	400 FRANKLIN TPKE
Second Line	:	SUITE 202
City	:	MAHWAH
State	:	NJ
Zip	:	07430-3516
Country	:	US
Telephone Number	:	201-818-9114
Fax Number	:	201-934-8223

Provider Business Practice Location Address
First Line	:	400 FRANKLIN TPKE
Second Line	:	SUITE 202
City	:	MAHWAH
State	:	NJ
Zip	:	07430-3516
Country	:	US
Telephone Number	:	201-818-9114
Fax Number	:	201-934-8223

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	05/11/2011

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