Provider Demographics
NPI:1386645315
Name:ELIMIAN, ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:ELIMIAN
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 1:19 BRADHURST AVENUE, SUITE 3100N
Mailing Address - Street 2:WMC ADVANCED PHYSICIAN SERVICES, PC
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532
Mailing Address - Country:US
Mailing Address - Phone:914-909-9018
Mailing Address - Fax:
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:SUITE 2700
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532
Practice Address - Country:US
Practice Address - Phone:914-493-2250
Practice Address - Fax:914-493-2060
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189811207V00000X, 207VM0101X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01739940Medicaid
NY01739940Medicaid
NYG89599Medicare UPIN