=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205829611
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAURICE ELISH MARKEWICH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2005
-----------------------------------------------------
Last Update Date | 12/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 E 21ST ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10010-6543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-674-2979
-----------------------------------------------------
Fax | 212-420-2044
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 65 BACON HILL RD
-----------------------------------------------------
City | PLEASANTVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10570-3501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-769-7114
-----------------------------------------------------
Fax | 212-420-2044
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 109150
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------