Provider Demographics
NPI:1881387561
Name:BRANDON M. ELNEKAVEH, MD PLLC
Entity type:Organization
Organization Name:BRANDON M. ELNEKAVEH, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:MORDECCAI
Authorized Official - Last Name:ELNEKAVEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-603-9155
Mailing Address - Street 1:394 E SHORE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2402
Mailing Address - Country:US
Mailing Address - Phone:516-603-9155
Mailing Address - Fax:
Practice Address - Street 1:394 E SHORE RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2402
Practice Address - Country:US
Practice Address - Phone:516-603-9155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty