Healthcare Provider Details

I. General information

NPI: 1144800574
Provider Name (Legal Business Name): MADHAVAN ELANGOVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE 3060N
HAWTHORNE NY
10532-2180
US

IV. Provider business mailing address

19 BRADHURST AVE STE 3060N
HAWTHORNE NY
10532-2180
US

V. Phone/Fax

Practice location:
  • Phone: 914-592-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number336665
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: