Provider Demographics
NPI:1174921738
Name:ELAD, EKO
Entity type:Individual
Prefix:
First Name:EKO
Middle Name:
Last Name:ELAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6353 64TH AVE APT C4
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1501
Mailing Address - Country:US
Mailing Address - Phone:281-818-1426
Mailing Address - Fax:
Practice Address - Street 1:6353 64TH AVE APT C4
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1501
Practice Address - Country:US
Practice Address - Phone:281-818-1426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA10408374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide