MEDICARE: GREAT NECK NY MEDICAL PLLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1386595932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT NECK NY MEDICAL PLLC

Provider Business Mailing Address
First Line	:	255 GREAT NECK RD APT 502
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-3362
Country	:	US
Telephone Number	:	516-660-6344
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 GREAT NECK RD APT 502
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-3362
Country	:	US
Telephone Number	:	516-660-6344
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MAEKAL ELYASI
Credential	:
Telephone Number	:	516-660-6344

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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