Provider Demographics
NPI:1588767438
Name:ELI ANKER M.D.,P.C.
Entity type:Organization
Organization Name:ELI ANKER M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-422-0909
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:754 MONTAUK HIGHWAY
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-0070
Mailing Address - Country:US
Mailing Address - Phone:631-422-0909
Mailing Address - Fax:631-422-6660
Practice Address - Street 1:754 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4908
Practice Address - Country:US
Practice Address - Phone:631-422-0909
Practice Address - Fax:631-422-6660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMD116921208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20042896OtherRAILROAD MEDICARE
NY00242493Medicaid
NYCS209OtherOXFORD
NY1042023OtherUNITED HEALTHCARE
NY10313OtherVYTRA
NY81L221Medicare ID - Type Unspecified
NY81L22XW551Medicare PIN
NY00242493Medicaid