Individual
ELIJAH JOHN ROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1468 MADISON AVE, NEW YORK, NY 10029-6508
(929) 695-1273
Mailing address
321 E 115TH ST, NEW YORK, NY 10029-2234
(216) 368-0575
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
031382
NY
363A00000X
Physician Assistant
—
—
Other
Enumeration date
06/29/2022
Last updated
06/26/2025
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