Provider Demographics
NPI:1912918970
Name:ELIASOPH, IRA (MD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:
Last Name:ELIASOPH
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 1:133 EAST 73RD STREET
Mailing Address - Street 2:SUITE 501
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3556
Mailing Address - Country:US
Mailing Address - Phone:212-988-4800
Mailing Address - Fax:212-472-6883
Practice Address - Street 1:133 E 73RD ST
Practice Address - Street 2:SUITE 501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3556
Practice Address - Country:US
Practice Address - Phone:212-988-4800
Practice Address - Fax:212-472-6883
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074243207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS4178OtherOXFORD
11558Medicare ID - Type Unspecified
NYNS4178OtherOXFORD