Provider Demographics
NPI:1164643490
Name:EL-CHARABATY, ELIE JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:ELIE
Middle Name:JOSEPH
Last Name:EL-CHARABATY
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 1:97 NEW DORP LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2364
Mailing Address - Country:US
Mailing Address - Phone:718-876-6220
Mailing Address - Fax:718-876-5969
Practice Address - Street 1:470 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3401
Practice Address - Country:US
Practice Address - Phone:718-987-5940
Practice Address - Fax:718-667-9708
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251562174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02882497Medicaid
06331425OtherECFMG #
NYA400070307OtherPTAN
NY83761EMedicare Oscar/Certification
NY83761EL471Medicare PIN