Eliazo, Ethelwoldo
Eliazo, Ethelwoldo is an sole proprietor health care provider with primary practice located at 15211 89Th Ave , Jamaica NY 11432-3730. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Eliazo, Ethelwoldo can be contacted via phone (718) 558-2275.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 130797 | New York |
Profile Details
| NPI number | 1588794820 |
|---|---|
| LBN Legal business name | Eliazo, Ethelwoldo |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 6th, 2007 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1588794820 | NPPES |
| New York | MEDICAID | 01010746 |
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