Healthcare Provider Details

I. General information

NPI: 1336856319
Provider Name (Legal Business Name): ELSSY N. OMS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S AUSTRALIAN AVE STE 422
WEST PALM BEACH FL
33401-5004
US

IV. Provider business mailing address

400 S AUSTRALIAN AVE STE 422
WEST PALM BEACH FL
33401-5004
US

V. Phone/Fax

Practice location:
  • Phone: 561-295-7070
  • Fax:
Mailing address:
  • Phone: 786-853-9159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ELSSY OMS
Title or Position: PRESIDENT
Credential: MD
Phone: 786-853-9159