Provider Demographics
NPI:1396756607
Name:ELASHVILI, MERY (MD)
Entity type:Individual
Prefix:DR
First Name:MERY
Middle Name:
Last Name:ELASHVILI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 MAMARONECK AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2523
Mailing Address - Country:US
Mailing Address - Phone:914-597-2362
Mailing Address - Fax:914-597-2815
Practice Address - Street 1:785 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2523
Practice Address - Country:US
Practice Address - Phone:914-597-2362
Practice Address - Fax:914-597-2815
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209281174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01792938Medicaid
NY93Y713Medicare ID - Type Unspecified
NY01792938Medicaid