Provider Demographics
NPI:1144310525
Name:ELIZEE, JULIEN (MD)
Entity type:Individual
Prefix:DR
First Name:JULIEN
Middle Name:
Last Name:ELIZEE
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 1:4519 IRIS LN
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020-1063
Mailing Address - Country:US
Mailing Address - Phone:516-829-8190
Mailing Address - Fax:516-467-4887
Practice Address - Street 1:808 LINCOLN PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4302
Practice Address - Country:US
Practice Address - Phone:718-953-4653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159159207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00885121Medicaid
NY44D463Medicare ID - Type Unspecified
NY00885121Medicaid