Provider Demographics
NPI:1346210382
Name:SHRECK, ELISE H (MD)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:H
Last Name:SHRECK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:52 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507-1814
Mailing Address - Country:US
Mailing Address - Phone:914-666-2220
Mailing Address - Fax:914-666-2987
Practice Address - Street 1:150 E SUNRISE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2598
Practice Address - Country:US
Practice Address - Phone:631-225-7200
Practice Address - Fax:631-225-4565
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2016-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1732892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01148856Medicaid
F86818Medicare UPIN
NY01148856Medicaid