Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 248946-1 | NY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 248946-1 | NY |
NPI | 1083874226 |
---|---|
Provider Name | Rashiah Elam |
First Address | Nyack, NY 10960-1641 |
Second Address | Nyack, NY 10960-1641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 27/09/2019 |