Provider Demographics
NPI:1588691364
Name:FLINK, ELISHEVA (MD)
Entity type:Individual
Prefix:
First Name:ELISHEVA
Middle Name:
Last Name:FLINK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELISHEVA
Other - Middle Name:
Other - Last Name:HETTINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:80 MARCUS DR
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4230
Mailing Address - Country:US
Mailing Address - Phone:631-391-7887
Mailing Address - Fax:631-454-4163
Practice Address - Street 1:516 E. NIZHONI BLVD.
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-1337
Practice Address - Country:US
Practice Address - Phone:505-722-1000
Practice Address - Fax:505-722-1256
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201650207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01708369Medicaid
NY01708369Medicaid
NY5325PQMedicare PIN