Provider Demographics
NPI:1750359014
Name:ELIHU, SHAHRYAR (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHRYAR
Middle Name:
Last Name:ELIHU
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 1:320 E SHORE RD
Mailing Address - Street 2:4C
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1733
Mailing Address - Country:US
Mailing Address - Phone:516-902-0270
Mailing Address - Fax:516-747-4783
Practice Address - Street 1:320 E SHORE RD
Practice Address - Street 2:4C
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1733
Practice Address - Country:US
Practice Address - Phone:516-902-0270
Practice Address - Fax:516-747-4783
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225921207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02362389Medicaid
NY02362389Medicaid
H71781Medicare UPIN