Provider Demographics
NPI:1083708051
Name:UDELL, ELLIOT T (DPM)
Entity type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:T
Last Name:UDELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 BETHPAGE RD
Mailing Address - Street 2:206
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-1515
Mailing Address - Country:US
Mailing Address - Phone:516-935-1113
Mailing Address - Fax:516-938-8613
Practice Address - Street 1:120 BETHPAGE RD
Practice Address - Street 2:206
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-1515
Practice Address - Country:US
Practice Address - Phone:516-935-1113
Practice Address - Fax:516-938-8613
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002768213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T50891Medicare UPIN
NY0137790001Medicare NSC
NYP3140YTX31Medicare PIN
NYP31401Medicare PIN