Individual
ELISA RUSH PORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1176 5TH AVE, NEW YORK, NY 10029-6503
(212) 241-3300
Mailing address
150 E 42ND ST FL 10, NEW YORK, NY 10017-5612
(212) 987-3100
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
198721
NY
2086X0206X
Surgical Oncology Physician
Primary
198721
NY
Other
Enumeration date
12/07/2005
Last updated
04/04/2023
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