Provider Demographics
NPI:1962441113
Name:PAUL, ELLIOT M (MD)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:M
Last Name:PAUL
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 1:2001 MARCUS AVE STE N214
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1087
Mailing Address - Country:US
Mailing Address - Phone:516-437-4228
Mailing Address - Fax:516-355-0637
Practice Address - Street 1:2001 MARCUS AVE STE N214
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1087
Practice Address - Country:US
Practice Address - Phone:516-437-4228
Practice Address - Fax:516-355-0637
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223788208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI43637Medicare UPIN
NY9255TMMedicare ID - Type Unspecified