Provider Demographics
NPI:1689826950
Name:FAVUS, ELLIOT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:J
Last Name:FAVUS
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:PO BOX 1003
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10276-1003
Mailing Address - Country:US
Mailing Address - Phone:917-952-8158
Mailing Address - Fax:
Practice Address - Street 1:202 W 24TH ST
Practice Address - Street 2:CUCS-THE CHRISTOPHER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1704
Practice Address - Country:US
Practice Address - Phone:917-952-8158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-18
Last Update Date:2008-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231130207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine