Provider Demographics
NPI:1609455476
Name:ELFAWAL, DAVID (LMT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ELFAWAL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6215
Mailing Address - Country:US
Mailing Address - Phone:516-541-8933
Mailing Address - Fax:516-549-5034
Practice Address - Street 1:5509 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6215
Practice Address - Country:US
Practice Address - Phone:516-541-8933
Practice Address - Fax:516-549-5034
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020281225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty