Elliot Lance Forman, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

04839 Issued in NY

Practice address

515 Route 111
Suite 101
Hauppauge, NY 11788-4339

Phone

(631) 265-2225

Fax

(631) 265-3610

NPI assigned

Oct 25, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Chiropractic

Education

New York Chiropractic College, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• 515 Physical Therapy LLC

  • Physical Therapist
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  • NPI 1043314172
  NPD (past)
• Advanced Rehab Medical Services, P.C.

  • Physical Medicine & Rehabilitation Physician
  • Brentwood, NY
  • NPI 1508886896
  NPD (past)

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902980071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 ROUTE 111",
            "address_2": "SUITE 101",
            "city": "HAUPPAUGE",
            "state": "NY",
            "postal_code": "117884339",
            "telephone_number": "631-265-2225",
            "fax_number": "631-265-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 ROUTE 111",
            "address_2": "SUITE 101",
            "city": "HAUPPAUGE",
            "state": "NY",
            "postal_code": "117884339",
            "telephone_number": "631-265-2225",
            "fax_number": "631-265-3610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "ELLIOT",
        "middle_name": "LANCE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "04839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nikki Taylor Fogarty, LMSW
• Kaela Fogelstrom, MS, OTR/L
• Susan Folks
• Samantha Elizabeth Fontana, LMHC
• Elaine Ford, LCSW
• Deandra Foster
• Migdalia Fox
• Deborah Frallicciardi, M.S. EDUCATION
• Leonard Martin Framson, PT
• Jason Francis, DDS

• Chiropractor in Hauppauge, NY
• Providers in Hauppauge, NY by specialty
• Chiropractor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.