Provider Demographics
NPI:1326832239
Name:ELEVAE PLLC
Entity type:Organization
Organization Name:ELEVAE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:917-936-5660
Mailing Address - Street 1:79 HARBOR DR APT 313
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-7480
Mailing Address - Country:US
Mailing Address - Phone:917-936-5660
Mailing Address - Fax:
Practice Address - Street 1:100 MELROSE AVE STE 101
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6277
Practice Address - Country:US
Practice Address - Phone:917-936-5660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center