MEDICARE: DR. ELAJAH DENIS DNP, CRNA

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	367500000X	Certified Registered Nurse Anesthetist	772660	NY
2	163W00000X	Registered Nurse	772660	NY
3	164W00000X	Licensed Practical Nurse	326335	NY

General Provider Information

NPI Number	:	1760922611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELAJAH DENIS DNP, CRNA

Provider Business Mailing Address
First Line	:	3601 LIBERTY AVE # 511
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-2335
Country	:	US
Telephone Number	:	516-673-8406
Fax Number	:

Provider Business Practice Location Address
First Line	:	388 MIDWOOD ST
Second Line	:	3I
City	:	BROOKLYN
State	:	NY
Zip	:	11225-5449
Country	:	US
Telephone Number	:	516-673-8406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2017
Last Update Date	:	01/15/2026

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