Healthcare Provider Details

I. General information

NPI: 1093694507
Provider Name (Legal Business Name): ELIE SADER, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MYANO LN STE 22
STAMFORD CT
06902-4532
US

IV. Provider business mailing address

136 MADISON AVE # 4648
NEW YORK NY
10016-6711
US

V. Phone/Fax

Practice location:
  • Phone: 203-635-8780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIE SADER
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 617-671-9365