Provider Demographics
NPI:1912013376
Name:LADELL, ELIYAHU SHALOM (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIYAHU
Middle Name:SHALOM
Last Name:LADELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:79 ROUTE 59
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4913
Mailing Address - Country:US
Mailing Address - Phone:845-368-4260
Mailing Address - Fax:845-368-4265
Practice Address - Street 1:79 ROUTE 59
Practice Address - Street 2:SUITE 2
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4913
Practice Address - Country:US
Practice Address - Phone:845-368-4260
Practice Address - Fax:845-368-4265
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY147629208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01508525Medicaid
NYB39018Medicare UPIN
NY01508525Medicaid