Provider Demographics
NPI:1598856825
Name:ELIAZ, IZHAR (PHD)
Entity Type:Individual
Prefix:
First Name:IZHAR
Middle Name:
Last Name:ELIAZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11701 PARK LN S
Mailing Address - Street 2:APT A6E
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1024
Mailing Address - Country:US
Mailing Address - Phone:347-735-8255
Mailing Address - Fax:
Practice Address - Street 1:11701 PARK LN S
Practice Address - Street 2:APT A6E
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1024
Practice Address - Country:US
Practice Address - Phone:347-735-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015212-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
EMPIRE MEDICARE`Medicare ID - Type UnspecifiedPENDING