MEDICARE: NATARAJAN ELANGOVAN M.D.

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
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1396364436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATARAJAN ELANGOVAN M.D.

Provider Business Mailing Address
First Line	:	1756 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3902
Country	:	US
Telephone Number	:	718-477-5670
Fax Number	:

Provider Business Practice Location Address
First Line	:	1756 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3902
Country	:	US
Telephone Number	:	718-477-5670
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JUDY MARIE GERDTS
Credential	:
Telephone Number	:	718-477-5670

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	02/07/2022

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