Provider Demographics
NPI:1306086988
Name:SHAHRYAR ELIHU M.D.
Entity type:Organization
Organization Name:SHAHRYAR ELIHU M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-761-1234
Mailing Address - Street 1:320 E SHORE RD
Mailing Address - Street 2:4C
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1733
Mailing Address - Country:US
Mailing Address - Phone:631-271-9151
Mailing Address - Fax:
Practice Address - Street 1:320 E SHORE RD
Practice Address - Street 2:4C
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1733
Practice Address - Country:US
Practice Address - Phone:516-761-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225921207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY51S961Medicare UPIN