Healthcare Provider Details

I. General information

NPI: 1477506947
Provider Name (Legal Business Name): IMAN ELTAY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IMAN GRISCHY PA

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 ARBOR SQUARE DR
MASON OH
45040-5000
US

IV. Provider business mailing address

8350 ARBOR SQUARE DR
MASON OH
45040-5000
US

V. Phone/Fax

Practice location:
  • Phone: 513-346-3399
  • Fax:
Mailing address:
  • Phone: 513-346-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA890
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50002267
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: