Provider Demographics
NPI:1629270459
Name:DEHAAN, ELLIOT NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:NEIL
Last Name:DEHAAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:401 N MIDDLETOWN RD
Mailing Address - Street 2:ATTN: DR. ELLIOT DEHAAN, BUILDING 190/FLOOR 4
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965
Mailing Address - Country:US
Mailing Address - Phone:646-285-5372
Mailing Address - Fax:
Practice Address - Street 1:401 N MIDDLETOWN RD
Practice Address - Street 2:ATTN: DR. ELLIOT DEHAAN, BUILDING 190/FLOOR 4
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965
Practice Address - Country:US
Practice Address - Phone:646-285-5372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247859207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331945Medicare Oscar/Certification
NY331952Medicare Oscar/Certification
NY00695941Medicaid