Provider Demographics
NPI:1366775066
Name:ELIE, M N MELISSA (RPA-C)
Entity type:Individual
Prefix:
First Name:M N MELISSA
Middle Name:
Last Name:ELIE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:MARIE MELISSA
Other - Middle Name:
Other - Last Name:ELIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:600 E 233RD ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2604
Mailing Address - Country:US
Mailing Address - Phone:718-920-9135
Mailing Address - Fax:
Practice Address - Street 1:600 E 233RD ST
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2604
Practice Address - Country:US
Practice Address - Phone:718-920-9135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-12
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112369363A00000X
NY013405363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant