Provider Demographics
NPI:1710939541
Name:ELAHI, EBRAHIM (MD)
Entity Type:Individual
Prefix:
First Name:EBRAHIM
Middle Name:
Last Name:ELAHI
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 1:1034 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0157
Mailing Address - Country:US
Mailing Address - Phone:212-570-0707
Mailing Address - Fax:212-570-0555
Practice Address - Street 1:1034 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0157
Practice Address - Country:US
Practice Address - Phone:212-570-0707
Practice Address - Fax:212-570-0555
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207710-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH17819Medicare UPIN