Provider Demographics
NPI:1124123286
Name:ELLIOT BELENKOV PHYSICIAN PC
Entity type:Organization
Organization Name:ELLIOT BELENKOV PHYSICIAN PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELENKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-472-5500
Mailing Address - Street 1:178 E 85TH ST
Mailing Address - Street 2:4 FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2119
Mailing Address - Country:US
Mailing Address - Phone:212-472-5500
Mailing Address - Fax:
Practice Address - Street 1:178 E 85TH ST
Practice Address - Street 2:4 FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2119
Practice Address - Country:US
Practice Address - Phone:212-472-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01867252Medicaid
NYWX0641Medicare ID - Type Unspecified
NYWX0642Medicare ID - Type UnspecifiedBROOKLYN OFFICE