MEDICARE: A ELASSAR MEDICAL PRACTICE P.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	263089-1	NY

General Provider Information

NPI Number	:	1043714603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A ELASSAR MEDICAL PRACTICE P.C

Provider Business Mailing Address
First Line	:	693 5TH AVE FL 7
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-3164
Country	:	US
Telephone Number	:	800-853-7595
Fax Number	:	800-780-6167

Provider Business Practice Location Address
First Line	:	693 5TH AVE FL 7
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-3164
Country	:	US
Telephone Number	:	800-853-7595
Fax Number	:	800-780-6167

Authorized Official
Title or Position	:	MD/PRESIDENT
Name	:	DR. ALYAA ELASSAR
Credential	:	MD
Telephone Number	:	800-853-7595

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	03/20/2018

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