Provider Demographics
NPI:1609804053
Name:ASH, ELISSA L (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:L
Last Name:ASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 BIRCHWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2307
Mailing Address - Country:US
Mailing Address - Phone:212-795-8779
Mailing Address - Fax:
Practice Address - Street 1:278 BIRCHWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2307
Practice Address - Country:US
Practice Address - Phone:212-795-8779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY489642084N0400X
NY2231522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02717251Medicaid
KY7100397370Medicaid