Healthcare Provider Details

I. General information

NPI: 1306009733
Provider Name (Legal Business Name): ELIAS DAKWAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 RIVERSIDE DR
NEW YORK NY
10032-1007
US

IV. Provider business mailing address

1051 RIVERSIDE DR
NEW YORK NY
10032-1007
US

V. Phone/Fax

Practice location:
  • Phone: 773-314-6779
  • Fax:
Mailing address:
  • Phone: 773-314-6779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number60249092
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: