Healthcare Provider Details

I. General information

NPI: 1164643490
Provider Name (Legal Business Name): ELIE JOSEPH EL-CHARABATY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 SEAVIEW AVE
STATEN ISLAND NY
10305-3401
US

IV. Provider business mailing address

97 NEW DORP LN SUITE A
STATEN ISLAND NY
10306-2364
US

V. Phone/Fax

Practice location:
  • Phone: 718-987-5940
  • Fax: 718-667-9708
Mailing address:
  • Phone: 718-876-6220
  • Fax: 718-876-5969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number251562
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: