Kethia Eliezer, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

66311 Issued in CT

Practice address

126 Morgan St
Stamford, CT 06905-5431

Phone

(203) 327-1055

Fax

(203) 323-6177

NPI assigned

Apr 15, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: keliezer24364@stamfordhealth.direct-ci.com
• FHIR API: https://fhir4.healow.com/fhir/r4/ABCIBA

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.

• Stamford Health Medical Group Inc

  • General Practice Physician
  • Stamford, CT
  • NPI 1154633980
  Medicare reassignment NPD

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

{
    "created_epoch": "1492214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595462400000",
    "number": "1285168328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 MORGAN ST",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069055431",
            "telephone_number": "203-327-1055",
            "fax_number": "203-323-6177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 MORGAN ST",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069055431",
            "telephone_number": "203-327-1055",
            "fax_number": "203-323-6177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELIEZER",
        "first_name": "KETHIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-15",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "66311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elevate Physiotherapy, LLC
• Elevate PT- Stamford PLLC
• Elevolve, PLLC
• Samantha Rose Elia
• Elie Sader, MD, PLLC
• Elite Personal Fitness LTD
• Destiny Shanay Elliott
• Tothlyn Ellis, NP
• Karim Elmansoury, DDS
• Genevieve Eloskof, BCBA

• Pediatrics Physician in Stamford, CT
• Providers in Stamford, CT by specialty
• Pediatrics Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.