Provider Demographics
NPI:1851305676
Name:SOCOLOF, ELIAS A (MD)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:A
Last Name:SOCOLOF
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 1:9 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7880
Mailing Address - Country:US
Mailing Address - Phone:518-761-0300
Mailing Address - Fax:518-824-2388
Practice Address - Street 1:28 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-3323
Practice Address - Country:US
Practice Address - Phone:518-798-6400
Practice Address - Fax:518-798-4105
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201597208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01744967Medicaid
NYG53232Medicare UPIN
NY01744967Medicaid