Provider Demographics
NPI:1003334137
Name:MCELROY, REGINA MARIE
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:MCELROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24902 JERICHO TPKE STE 207
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-4000
Mailing Address - Country:US
Mailing Address - Phone:718-635-2404
Mailing Address - Fax:718-889-7400
Practice Address - Street 1:24902 JERICHO TPKE STE 207
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-4000
Practice Address - Country:US
Practice Address - Phone:718-635-2404
Practice Address - Fax:718-889-7400
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY893355174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist