Provider Demographics
NPI:1417965146
Name:NADELSON, ELLIOT JAY (MD)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:JAY
Last Name:NADELSON
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 1:53 W 36TH ST STE 204A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-7903
Mailing Address - Country:US
Mailing Address - Phone:212-727-2887
Mailing Address - Fax:646-774-0936
Practice Address - Street 1:53 W 36TH ST STE 204A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7903
Practice Address - Country:US
Practice Address - Phone:212-727-2887
Practice Address - Fax:646-774-0936
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140064208D00000X, 208800000X
CAC145147208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00776747Medicaid
B79909Medicare UPIN
94A301Medicare ID - Type Unspecified