Healthcare Provider Details

I. General information

NPI: 1629495163
Provider Name (Legal Business Name): ELISA RHEE M.B.B.CH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2014
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MARCUS AVE STE M15
NEW HYDE PARK NY
11042-1034
US

IV. Provider business mailing address

1111 MARCUS AVE STE M15
NEW HYDE PARK NY
11042-1034
US

V. Phone/Fax

Practice location:
  • Phone: 516-601-7303
  • Fax: 516-601-7380
Mailing address:
  • Phone: 516-601-7303
  • Fax: 516-601-7380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number322068-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: