Provider Demographics
NPI:1174578132
Name:ENKER, PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:ENKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 NORTHERN BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5323
Mailing Address - Country:US
Mailing Address - Phone:516-773-7500
Mailing Address - Fax:516-772-7575
Practice Address - Street 1:825 NORTHERN BLVD STE 201
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5323
Practice Address - Country:US
Practice Address - Phone:516-838-8490
Practice Address - Fax:516-773-7575
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195459207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01597713Medicaid
NYA400160696Medicare PIN
NY01597713Medicaid
NY71I103K511Medicare PIN