Provider Demographics
NPI:1497924617
Name:ELIAV, IGOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:IGOR
Middle Name:
Last Name:ELIAV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 NASSAU AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222
Mailing Address - Country:US
Mailing Address - Phone:718-383-1270
Mailing Address - Fax:718-383-1271
Practice Address - Street 1:203 NASSAU AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222
Practice Address - Country:US
Practice Address - Phone:718-383-1270
Practice Address - Fax:718-383-1271
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046661122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01671741Medicaid