Provider Demographics
NPI:1720078413
Name:GITLITZ, ELLIOT M (DPM)
Entity type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:M
Last Name:GITLITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WATER ST
Mailing Address - Street 2:2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:3175 23RD ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-4134
Practice Address - Country:US
Practice Address - Phone:718-956-2200
Practice Address - Fax:718-956-2316
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003465213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP39163OtherEMPIRE BLUE CROSS/BLUE SH
NY00821958Medicaid
NY57006AOtherGHI PROVIDER ID
NY00821958Medicaid
NY9255OPMedicare PIN