Provider Demographics
NPI:1649410762
Name:ELBAYADI, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:ELBAYADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 W TAFT RD
Mailing Address - Street 2:STE H
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4868
Mailing Address - Country:US
Mailing Address - Phone:315-452-3235
Mailing Address - Fax:315-452-5726
Practice Address - Street 1:5112 W TAFT RD
Practice Address - Street 2:STE H
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4868
Practice Address - Country:US
Practice Address - Phone:315-452-3235
Practice Address - Fax:315-452-5726
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259225-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400048705Medicare PIN