Provider Demographics
NPI:1316366461
Name:ELNEKAVEH, BRANDON M (MD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:M
Last Name:ELNEKAVEH
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 1:815 HUTCHINSON RIVER PKWY STE 793
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1882
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:815 HUTCHINSON RIVER PKWY STE 793
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1882
Practice Address - Country:US
Practice Address - Phone:718-792-4700
Practice Address - Fax:718-792-1255
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA279276208200000X, 208600000X
NY285018208600000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery