Provider Demographics
NPI:1598714693
Name:FIFTH AVENUE OCULOFACIAL AESTHETIC SURGERY PC
Entity Type:Organization
Organization Name:FIFTH AVENUE OCULOFACIAL AESTHETIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELAHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-570-0707
Mailing Address - Street 1:1034 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0157
Mailing Address - Country:US
Mailing Address - Phone:212-570-0707
Mailing Address - Fax:
Practice Address - Street 1:1034 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0157
Practice Address - Country:US
Practice Address - Phone:212-570-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWER761Medicare ID - Type Unspecified