Healthcare Provider Details

I. General information

NPI: 1043250285
Provider Name (Legal Business Name): SCOTT A ELY M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

1275 YORK AVE
NEW YORK NY
10065-6007
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-2410
  • Fax: 212-772-8521
Mailing address:
  • Phone: 212-639-2410
  • Fax: 212-772-8521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number203194
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number203194
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: