Healthcare Provider Details

I. General information

NPI: 1417965146
Provider Name (Legal Business Name): ELLIOT JAY NADELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 W 36TH ST STE 204A
NEW YORK NY
10018-7903
US

IV. Provider business mailing address

53 W 36TH ST STE 204A
NEW YORK NY
10018-7903
US

V. Phone/Fax

Practice location:
  • Phone: 212-727-2887
  • Fax: 646-774-0936
Mailing address:
  • Phone: 212-727-2887
  • Fax: 646-774-0936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number140064
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC145147
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number140064
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: