Healthcare Provider Details

I. General information

NPI: 1083874226
Provider Name (Legal Business Name): RASHIAH ELAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 PIERMONT AVENUE SUITE 1A
NYACK NY
10960-1641
US

IV. Provider business mailing address

294 PIERMONT AVENUE SUITE 1A
NYACK NY
10960-1641
US

V. Phone/Fax

Practice location:
  • Phone: 917-736-7577
  • Fax:
Mailing address:
  • Phone: 917-736-7577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number248946-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number248946-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: