Provider Demographics
NPI:1104995356
Name:SERUR, ELI (MD)
Entity type:Individual
Prefix:MR
First Name:ELI
Middle Name:
Last Name:SERUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 SEAVIEW AVE
Mailing Address - Street 2:2ND FLOOR- OB/GYN
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3436
Mailing Address - Country:US
Mailing Address - Phone:718-226-8106
Mailing Address - Fax:718-226-8139
Practice Address - Street 1:475 SEAVIEW AVE
Practice Address - Street 2:2ND FLOOR- OB/GYN
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3436
Practice Address - Country:US
Practice Address - Phone:718-226-8106
Practice Address - Fax:718-226-8139
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170788207VX0201X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01231983Medicaid
NY77F411Medicare ID - Type Unspecified
NY01231983Medicaid