Provider Demographics
NPI:1063152585
Name:CECIL, ELLIOT (DO)
Entity type:Individual
Prefix:
First Name:ELLIOT
Middle Name:
Last Name:CECIL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W 97TH ST STE 1J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6001
Mailing Address - Country:US
Mailing Address - Phone:317-502-4797
Mailing Address - Fax:
Practice Address - Street 1:50 W 97TH ST STE 1J
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6001
Practice Address - Country:US
Practice Address - Phone:317-449-9491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338636204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM