Healthcare Provider Details

I. General information

NPI: 1619871639
Provider Name (Legal Business Name): ELLIOT ALEXIS VAN NOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

663 W LANCASTER AVE
BRYN MAWR PA
19010-3805
US

IV. Provider business mailing address

505 S 44TH ST # 2A
PHILADELPHIA PA
19104-3982
US

V. Phone/Fax

Practice location:
  • Phone: 610-658-0999
  • Fax:
Mailing address:
  • Phone: 540-808-9197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: