Healthcare Provider Details

I. General information

NPI: 1053839241
Provider Name (Legal Business Name): VIOLA ELEYAMMA GEORGE PA - C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

532 N 5TH ST
NEW HYDE PARK NY
11040-2929
US

V. Phone/Fax

Practice location:
  • Phone: 212-562-4311
  • Fax:
Mailing address:
  • Phone: 516-972-5673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number021177-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number021177
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: