Provider Demographics
NPI:1912053125
Name:JELKS, ELIZABETH BRADY (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BRADY
Last Name:JELKS
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 1:875 PARK AVE # 1C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0341
Mailing Address - Country:US
Mailing Address - Phone:212-988-3303
Mailing Address - Fax:212-988-7984
Practice Address - Street 1:875 PARK AVE APT 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0382
Practice Address - Country:US
Practice Address - Phone:212-988-3303
Practice Address - Fax:212-988-7984
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145807207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY26E881Medicare ID - Type Unspecified