Provider Demographics
NPI:1457900060
Name:MARIEL ELIZA, M.D., PLLC
Entity type:Organization
Organization Name:MARIEL ELIZA, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-234-0073
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-0404
Mailing Address - Country:US
Mailing Address - Phone:516-234-0073
Mailing Address - Fax:516-548-1530
Practice Address - Street 1:400 S OYSTER BAY RD STE 100
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3500
Practice Address - Country:US
Practice Address - Phone:516-234-0073
Practice Address - Fax:516-548-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty