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NPI Code Detail

MEDICARE: ENOCH ROSS ELLIOTT

MEDICARE:   ENOCH ROSS ELLIOTT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1184226995
Entity Type Code : Individual
Provider Name (Legal Business Name) : ENOCH ROSS ELLIOTT
Provider Business Mailing Address
First Line : 316 RUTLAND RD APT D8
Second Line :
City : BROOKLYN
State : NY
Zip : 11225-5476
Country : US
Telephone Number : 347-399-8450
Fax Number : 718-485-7780
Provider Business Practice Location Address
First Line : 2094 PITKIN AVE RM C-32A
Second Line :
City : BROOKLYN
State : NY
Zip : 11207-3509
Country : US
Telephone Number : 718-485-7760
Fax Number : 718-486-7780
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2020
Last Update Date : 11/16/2020

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Directions to “ ENOCH ROSS ELLIOTT ” Practice Location

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