Provider Demographics
NPI:1124031778
Name:SULEY, ELHAN A (DO)
Entity type:Individual
Prefix:
First Name:ELHAN
Middle Name:A
Last Name:SULEY
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 1:17 BLUEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6419
Mailing Address - Country:US
Mailing Address - Phone:516-225-9059
Mailing Address - Fax:516-558-0999
Practice Address - Street 1:157 GREENPOINT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-7099
Practice Address - Country:US
Practice Address - Phone:718-349-1200
Practice Address - Fax:718-349-1220
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02799879Medicaid
NY1374P1Medicare PIN
NYI19866Medicare UPIN