Provider Demographics
NPI:1992700116
Name:DILOS, ELENI J (MD)
Entity type:Individual
Prefix:DR
First Name:ELENI
Middle Name:J
Last Name:DILOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4927
Mailing Address - Country:US
Mailing Address - Phone:631-376-4174
Mailing Address - Fax:631-224-8560
Practice Address - Street 1:1000 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4927
Practice Address - Country:US
Practice Address - Phone:631-376-4174
Practice Address - Fax:631-224-8560
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY023SA1OtherBLUE CROSS BLUE SHIELD
NY02582332Medicaid
NY02585332OtherRAILROAD MEDICARE
NY0420S1Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
NY02582332Medicaid