Provider Demographics
NPI:1174373831
Name:ELIAS, EZRIEL MENDEL (MSW STUDENT)
Entity type:Individual
Prefix:
First Name:EZRIEL
Middle Name:MENDEL
Last Name:ELIAS
Suffix:
Gender:M
Credentials:MSW STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 FAIRWAY RD
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-5410
Mailing Address - Country:US
Mailing Address - Phone:347-522-5516
Mailing Address - Fax:
Practice Address - Street 1:4819 14TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3166
Practice Address - Country:US
Practice Address - Phone:718-559-2539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program