Healthcare Provider Details

I. General information

NPI: 1124286240
Provider Name (Legal Business Name): ELIE RAYMOND CHEMALY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2008
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL BOX 1030
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

157 E 85TH ST APT 2C
NEW YORK NY
10028-2322
US

V. Phone/Fax

Practice location:
  • Phone: 212-427-1540
  • Fax: 212-410-7196
Mailing address:
  • Phone: 646-596-7157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number14207003-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number246476
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: