Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | NY005404 | NY |
N | 2081S0010X | Sports Medicine | NY005404 | NY |
N | 213ES0000X | Sports Medicine | NY005404 | NY |
N | 213ES0131X | Foot Surgery | NY005404 | NY |
NPI | 1588647879 |
---|---|
Provider Name | Dr. Elvira Callahan |
First Address | Forest Hills, NY 11375-2455 |
Second Address | Forest Hills, NY 11375-2455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2005 |
Last Update Date | 11/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02043194 | (05) | NY |
4895450001 | MEDICARE DME (01) | NY |
U79862 | (02) | NY |