NPIMap

Individual provider Active NPI

Elisha Danzig, DO

  • Internal Medicine Physician
  • Watertown, CT
National Provider Identifier
1396360509
Registry record updated Jul 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
74008 Issued in CT
Practice address
70 Heminway Park Rd
Watertown, CT 06795-2612
Phone
(203) 709-5925
NPI assigned
Jun 12, 2020
Last updated
Jul 8, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 74008 CT Primary

Addresses

Primary practice location

70 Heminway Park Rd
Watertown, CT 06795-2612

Mailing address

754 Empire Ave
Far Rockaway, NY 11691-4835
Phone (917) 573-5379

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230803001766 CT Practitioner - Internal Medicine 4587025713 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rowan University School of Osteopathic Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

70 Heminway Park Rd
Watertown, CT 06795-2612
Phone (203) 709-5925

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Health of New England Provider Network Organization Inc Internal Medicine CurrentSince Aug 1, 2023 Accepting new patients
Trinity Health of New England Provider Network Organization Inc Internal Medicine CurrentSince Aug 1, 2023 Accepting new patients
Mercy Medical Group, Inc. Internal Medicine Past Accepting new patients

Locations

1300 Hall Blvd
Fl 3
Bloomfield, CT 06002
Phone (860) 714-2376

114 Woodland St
Hartford, CT 06105
Phone (860) 714-4001

70 Heminway Park Rd
Watertown, CT 06795
Phone (203) 709-5925

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1396360509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "754 EMPIRE AVE",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116914835",
            "telephone_number": "917-573-5379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 HEMINWAY PARK RD",
            "city": "WATERTOWN",
            "state": "CT",
            "postal_code": "067952612",
            "telephone_number": "203-709-5925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANZIG",
        "first_name": "ELISHA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-12",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "74008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, CT

Sources for this page

Verify at the official NPI Registry.