Provider Demographics
NPI:1235396607
Name:FORY, ELISSA KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:KAY
Last Name:FORY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELISSA
Other - Middle Name:FORY
Other - Last Name:WIBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:425 W 59TH ST
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-8022
Mailing Address - Country:US
Mailing Address - Phone:212-523-6521
Mailing Address - Fax:212-523-6962
Practice Address - Street 1:2799 W GRAND BLVD # K-11
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:800-653-6568
Practice Address - Fax:313-916-5117
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011153812084N0400X
NY2570942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology