Individual
ELISSA B GARTENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
7522 E 1ST ST, SCOTTSDALE, AZ 85251-4502
(602) 363-1631
(888) 360-8644
Mailing address
16211 N SCOTTSDALE RD, SCOTTSDALE, AZ 85254-1584
(602) 363-1631
(888) 360-8644
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4155
AZ
207Q00000X
Family Medicine Physician
5101015264
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
240988
—
AZ
01
—
Z154007
MEDICARE PTAN
AZ
Enumeration date
11/28/2005
Last updated
05/12/2015
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