Basic Information
| Provider Information | |||||||||
| NPI: | 1275518409 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | ELEAZAR | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 S BROAD ST STE 2230 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191101021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2677049669 | ||||||||
| FaxNumber: | 2675412658 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 S BROAD ST STE 2230 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191101021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2677049669 | ||||||||
| FaxNumber: | 2675412658 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2005 | ||||||||
| LastUpdateDate: | 10/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 226349 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LA0401X | 451804 | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Addiction Medicine | 207L00000X | 451804 | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 02657523 | 05 | NY | MEDICAID |