Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 115079-1 | NY |
Y | 208D00000X | General Practice Physician | 115079 | NY |
NPI | 1245269364 |
---|---|
Provider Name | Russell S Elwell |
First Address | Westfield, NY 14787-1155 |
Second Address | Westfield, NY 14787-1155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 30/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00010200001 | UNIVERA (01) | NY |
000507267001 | BLUE CROSS/SHIELD WNY (01) | NY |
00607790 | (05) | NY |
1702196 | INDEPENDENT HEALTH (01) | NY |
D01804 | (02) | NY |