Provider Demographics
NPI:1730113119
Name:ELZHOLZ, BRYAN MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:MATTHEW
Last Name:ELZHOLZ
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 1:2008 EASTCHESTER RD # LEVEL2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2252
Mailing Address - Country:US
Mailing Address - Phone:718-794-0600
Mailing Address - Fax:
Practice Address - Street 1:2008 EASTCHESTER RD # LEVEL2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2252
Practice Address - Country:US
Practice Address - Phone:718-794-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226364208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine