Provider Demographics
NPI:1689640476
Name:ELLOZY, SHARIF (MD)
Entity Type:Individual
Prefix:
First Name:SHARIF
Middle Name:
Last Name:ELLOZY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:BOX 1263
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6574
Mailing Address - Country:US
Mailing Address - Phone:212-241-4367
Mailing Address - Fax:212-987-9310
Practice Address - Street 1:5 EAST 98TH STREET
Practice Address - Street 2:3RD FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6574
Practice Address - Country:US
Practice Address - Phone:212-241-4367
Practice Address - Fax:212-987-9310
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY213237208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02431354Medicaid
NY1567N1Medicare ID - Type Unspecified
NY02431354Medicaid