ELIOT M WALLACK (NPI# 1750385449) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750385449 |
| Entity Type | Individual |
| Full Name | ELIOT M WALLACK |
| Credential | MD |
| Practice Address |
1840 South St Tuttleman Building Philadelphia PA 19146-7411 |
| Practice Telephone | 2158936200 |
| Mailing Telephone | 2158936200 |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2016-02-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
MD431377 | PA | Allopathic & Osteopathic Physicians |
| Street Address |
1840 SOUTH ST TUTTLEMAN BUILDING |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19146-7411 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750837225 | Faustin Shea | Physician Assistant | 1840 South St, Tuttleman Bldg,2nd Floor, Philadelphia, PA 19146-7411 | 2016-08-25 |
| 1013367606 | Akshay Bhatt | Student in an Organized Health Care Education/Training Program | 1840 South St, Philadelphia, PA 19146-7411 | 2016-06-15 |
| 1467890053 | Nadia Hasan | Family Medicine | 1840 South St, Philadelphia, PA 19146 | 2013-06-05 |
| 1568773042 | Monika Kumanova | Family Medicine | 1840 South St, Tuttleman Building, Philadelphia, PA 19146-7411 | 2010-06-29 |
| 1508866377 | Robert W Rothrock | Physician Assistant | 1840 South St, Tuttleman Building, 2nd Floor, Philadelphia, PA 19146-7411 | 2005-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114545977 | Puentes De Salvd | Clinic/Center | 1700 South Street, Philadelphia, PA 19146 | 2020-07-08 |
| 1407480155 | Mutiat Ajibade | Nurse Practitioner | 1401 S. 31 Street, Phialdelphia, PA 19146 | 2020-03-02 |
| 1003453952 | Bridget Smith | Psychologist | Stratton Hall, 3201 Chestnut St., 2nd Floor, Philadelphia, PA 19146 | 2019-12-10 |
| 1730678012 | Christina Martindale | Nurse Anesthetist, Certified Registered | 917 S 15th Street, Philadelphia, PA 19146 | 2018-05-02 |
| 1598289456 | Allison Ortolano | Speech-Language Pathologist | 1933 Montrose St., Philadelphia, PA 19146 | 2017-08-01 |
| 1033630116 | Jami F Young | Psychologist | 2716 South Street, Behavioral Health 8/8473, Philadelphia, PA 19146 | 2017-06-29 |
| 1336678788 | Joshua Ryan Fidler | Occupational Therapist | 2223 Wharton Street, Philadelphia, PA 19146 | 2017-06-08 |
| 1912357930 | Mei Lan Natalie Lau | Pharmacist | 3000-02 Reed Street, Philadelphia, PA 19146 | 2016-06-21 |
| 1417354887 | Brandy Mitchell | Specialist | 1608 Webster Street, Philadelphia, PA 19146 | 2014-12-01 |
| 1942638101 | Woong Yi | Pharmacist | 1155 S.mole St, Philadelphia, PA 19146 | 2013-10-28 |
| Find all providers in zip 19146 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972060176 | Ncv Diagnostics LLC | Psychiatry & Neurology | 1 Brown St Ste C, Philadelphia, PA 19123-3361 | 2019-02-23 |
| 1982102133 | Sonia Anand-nichols Md PC | Psychiatry & Neurology | 5735 Ridge Ave Ste 101, Philadelphia, PA 19128-1746 | 2018-01-23 |
| 1205357886 | Kenneth Gross | Psychiatry & Neurology | 777 S Broad St Apt 412, Philadelphia, PA 19147-2509 | 2017-07-04 |
| 1417339409 | Leonel Jorge Favio Estofan | Psychiatry & Neurology | 245 N 15th St, 7th Floor, Philadelphia, PA 19102-1200 | 2015-06-25 |
| 1073900700 | Pavan Anil Vaswani | Psychiatry & Neurology | 330 S 9th St Fl 3, Philadelphia, PA 19107-6103 | 2015-04-21 |
| 1942613369 | Mia Chwan Ko | Psychiatry & Neurology | 5401 Old York Rd Ste 404, Philadelphia, PA 19141-3046 | 2014-06-03 |
| 1912340415 | Simy Kabaria Parikh | Psychiatry & Neurology | 900 Walnut St Ste 200, Philadelphia, PA 19107-5191 | 2013-04-15 |
| 1215295118 | Curtis Brandon Allumbaugh | Psychiatry & Neurology | 833 Chestnut St Ste 220, Philadelphia, PA 19107 | 2012-04-27 |
| 1013201870 | Enrique Aradillas Lopez | Psychiatry & Neurology | 1200 Constitution Ave Ste 110, Philadelphia, PA 19112-1323 | 2011-06-08 |
| 1598076358 | Hristelina S. Ilieva | Psychiatry & Neurology | 909 Walnut Street 2nd Floor, Philadelphia, PA 19107-3342 | 2010-06-27 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19146 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.