Provider Demographics
NPI:1275587024
Name:ELIAS, STEVEN MARC (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARC
Last Name:ELIAS
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:PO BOX 27036
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7036
Mailing Address - Country:US
Mailing Address - Phone:212-342-4749
Mailing Address - Fax:201-816-8812
Practice Address - Street 1:350 ENGLE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1808
Practice Address - Country:US
Practice Address - Phone:212-342-4749
Practice Address - Fax:201-816-8812
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44570174400000X
NJMA445702086S0129X
NY14523412086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY467171OtherMEDICARE NY
NYA400087784Medicare PIN
NJ442714Medicare PIN
NJD18814Medicare UPIN