Provider Demographics
NPI:1699747774
Name:OKIN, ELIHU MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:ELIHU
Middle Name:MICHAEL
Last Name:OKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9140 ACADEMY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2853
Mailing Address - Country:US
Mailing Address - Phone:215-331-6050
Mailing Address - Fax:215-331-6055
Practice Address - Street 1:9140 ACADEMY RD
Practice Address - Street 2:SUITE A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2853
Practice Address - Country:US
Practice Address - Phone:215-331-6050
Practice Address - Fax:215-331-6055
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014140E207X00000X
NJ25MA02335000207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00074891500001Medicaid
PA0052390000OtherKEYSTONE
PA037952OtherBLUE SHIELD
PA00074891500001Medicaid
PA0052390000OtherKEYSTONE
NJ068183RLEMedicare ID - Type Unspecified