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General NPI Number Information
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NPI Number | 1952630444
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Entity Type | Individual
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Provider Name | IGOR GARY ELYASH D.O.
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Gender | Male
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Dates
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Enumeration Date | 12/14/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 344 SOUTH ST
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City | MORRISTOWN
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State | NJ
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Zip | 07960-6027
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Country | US
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Telephone | 973-267-2838
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Fax | 973-267-7909
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Provider Business Mailing Address
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Address Line | PO BOX 416457
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City | BOSTON
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State | MA
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Zip | 02241
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Country | US
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Telephone | 844-362-1735
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Fax | 973-290-7495
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MB09667800
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License Number State | NJ
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