MEDICARE: ELIE BOU SANAYEH 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1922795343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIE BOU SANAYEH M.D.

Provider Business Mailing Address
First Line	:	475 SEAVIEW AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3436
Country	:	US
Telephone Number	:	718-226-8313
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 SEAVIEW AVENUE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305
Country	:	US
Telephone Number	:	718-226-8313
Fax Number	:

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

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	06/02/2026

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