Provider Demographics
NPI:1801453741
Name:HOW, ELIJAH MOSES (DO)
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:MOSES
Last Name:HOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ELIJAH
Other - Middle Name:MOSES
Other - Last Name:HOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 RIVERSIDE BLVD APT 7N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0807
Mailing Address - Country:US
Mailing Address - Phone:817-235-9282
Mailing Address - Fax:
Practice Address - Street 1:550 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-5506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-27
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325820208100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program