Provider Demographics
NPI:1053532234
Name:CEDARHURST MEDICAL ASSOCIATES P.C.
Entity type:Organization
Organization Name:CEDARHURST MEDICAL ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DMITRIY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-471-7010
Mailing Address - Street 1:407 BEACH 20TH STREET
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691
Mailing Address - Country:US
Mailing Address - Phone:718-471-7010
Mailing Address - Fax:718-337-1548
Practice Address - Street 1:407 BEACH 20TH STREET
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-471-7010
Practice Address - Fax:718-337-1548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079794-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0009388OtherGHI
NY000451701OtherUS HEALTHCARE
NYCEOW024010OtherBLUE CHOICE
NY00791846Medicaid
NY00791846Medicaid
NYCEOW024010OtherBLUE CHOICE