Provider Demographics
NPI:1871644591
Name:ELLIOTT, FITZROY ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:FITZROY
Middle Name:ANTHONY
Last Name:ELLIOTT
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 1:115 W 116TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2521
Mailing Address - Country:US
Mailing Address - Phone:212-961-5741
Mailing Address - Fax:212-865-3581
Practice Address - Street 1:115 W 116TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-2521
Practice Address - Country:US
Practice Address - Phone:212-961-5741
Practice Address - Fax:212-865-3581
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172825207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE20418Medicare UPIN
NY22F251Medicare PIN