Provider Demographics
NPI:1942389309
Name:HAROUCHE, ELIE FREDERIC (MD, FACS)
Entity Type:Individual
Prefix:
First Name:ELIE
Middle Name:FREDERIC
Last Name:HAROUCHE
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0338
Mailing Address - Country:US
Mailing Address - Phone:212-570-1794
Mailing Address - Fax:516-367-4925
Practice Address - Street 1:903 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0338
Practice Address - Country:US
Practice Address - Phone:212-570-1794
Practice Address - Fax:516-367-4925
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136181208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO7417Medicare UPIN
NY26D71100Medicare ID - Type Unspecified