MEDICARE: ELAYA HEALTH MIDWEST LLC

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	363L00000X	Nurse Practitioner
2	204D00000X	Neuromusculoskeletal Medicine & OMM Physician

General Provider Information

NPI Number	:	1548192784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELAYA HEALTH MIDWEST LLC

Provider Business Mailing Address
First Line	:	284 PARK AVE
Second Line	:
City	:	PASSAIC
State	:	NJ
Zip	:	07055-4455
Country	:	US
Telephone Number	:	917-862-3003
Fax Number	:

Provider Business Practice Location Address
First Line	:	2515 LAURELHURST RD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-4611
Country	:	US
Telephone Number	:	917-862-3003
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	MEHRI SONGHORIAN
Credential	:	MD
Telephone Number	:	917-862-3003

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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