Healthcare Provider Details

I. General information

NPI: 1285597054
Provider Name (Legal Business Name): ELIAS TANNOUS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BACON RD
OLD WESTBURY NY
11568-1304
US

IV. Provider business mailing address

101 BACON RD
OLD WESTBURY NY
11568-1304
US

V. Phone/Fax

Practice location:
  • Phone: 516-776-4706
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3658004
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: