Provider Demographics
NPI:1043308695
Name:ELFENBEIN, JEFFREY NEAL (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:NEAL
Last Name:ELFENBEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2823
Mailing Address - Country:US
Mailing Address - Phone:516-785-0660
Mailing Address - Fax:516-785-1099
Practice Address - Street 1:3921 MERRICK RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2823
Practice Address - Country:US
Practice Address - Phone:516-785-0660
Practice Address - Fax:516-785-1099
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196802207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01607712Medicaid
F26729Medicare UPIN
NY01607712Medicaid