NPIMap

Individual provider Active NPI

Elissa Kay Fory, M.D.

  • Neurology Physician
  • Detroit, MI
National Provider Identifier
1235396607
Registry record updated May 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
4301115381 Issued in MI
Practice address
2799 W Grand Blvd # K-11
Detroit, MI 48202-2608
Phone
(800) 653-6568
Fax
(313) 916-5117
NPI assigned
May 21, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 4301115381 MI Primary

Addresses

Primary practice location

2799 W Grand Blvd # K-11
Detroit, MI 48202-2608

Mailing address

425 W 59TH St
Suite 6a
New York, NY 10019-8022
Phone (212) 523-6521

Other names 1

  • Elissa Fory Wible Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110301000828 NY Practitioner - Neurology 3971784570 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Tulane University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Icahn School of Medicine at Mount SinaiGroup PAC ID 2264691070, 2,809 clinicians

Practice addresses (Care Compare)

1000 10TH Ave
New York, NY 10019-1147
Phone (212) 523-6521

3160 21St St
Long Island City, NY 11106-4520
Phone (718) 808-7325

Hospital & facility affiliations

  • Mount Sinai Hospital Hospital, New York, NY, CCN 330024
  • Mount Sinai West Hospital, New York, NY, CCN 330046

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301115381MIMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai Neurology CurrentSince Oct 1, 2020 Accepting new patients
Department of Neurology Professional Services Group/Slrhc Neurology Past Accepting new patients

Locations

3160 21st St
Long Island City, NY 11106
Phone (718) 808-7300

2510 30th Ave
Long Island City, NY 11102
Phone (718) 267-4245

150 E 42nd St
Fl 10
New York, NY 10017
Phone (646) 605-8119

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: efory573238@direct.hfhs.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559088000000",
    "number": "1235396607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W 59TH ST",
            "address_2": "SUITE 6A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100198022",
            "telephone_number": "212-523-6521",
            "fax_number": "212-523-6962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2799 W GRAND BLVD # K-11",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608",
            "telephone_number": "800-653-6568",
            "fax_number": "313-916-5117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORY",
        "first_name": "ELISSA",
        "middle_name": "KAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-21",
        "last_updated": "2019-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301115381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELISSA",
            "last_name": "WIBLE",
            "middle_name": "FORY",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.