Provider Demographics
NPI:1821441890
Name:ELYASI, MAEKAL (DO)
Entity Type:Individual
Prefix:
First Name:MAEKAL
Middle Name:
Last Name:ELYASI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OLD COUNTRY RD STE 260
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4240
Mailing Address - Country:US
Mailing Address - Phone:516-742-8787
Mailing Address - Fax:516-742-0647
Practice Address - Street 1:1155 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3040
Practice Address - Country:US
Practice Address - Phone:516-407-4000
Practice Address - Fax:516-407-4193
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine