Provider Demographics
NPI:1427799485
Name:ELITE FEET PODIATRY PLLC
Entity type:Organization
Organization Name:ELITE FEET PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:J
Authorized Official - Last Name:NELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:607-215-5159
Mailing Address - Street 1:511 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:PA
Mailing Address - Zip Code:18810-1819
Mailing Address - Country:US
Mailing Address - Phone:607-215-5159
Mailing Address - Fax:
Practice Address - Street 1:180 N ELMIRA ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:PA
Practice Address - Zip Code:18810-1328
Practice Address - Country:US
Practice Address - Phone:607-215-5159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty