Healthcare Provider Details

I. General information

NPI: 1245204098
Provider Name (Legal Business Name): ELI BRYK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 WILLIAM ST 8TH FLOOR
NEW YORK NY
10038-2612
US

IV. Provider business mailing address

170 WILLIAM ST 8TH FLOOR
NEW YORK NY
10038-2612
US

V. Phone/Fax

Practice location:
  • Phone: 212-312-5990
  • Fax: 212-312-5480
Mailing address:
  • Phone: 212-312-5990
  • Fax: 212-312-5480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number160873
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: