Provider Demographics
NPI:1083022834
Name:ELANA Z KLEIN PHYSICIAN ASISTANT PC
Entity Type:Organization
Organization Name:ELANA Z KLEIN PHYSICIAN ASISTANT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELANA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:845-825-3502
Mailing Address - Street 1:19 CHARLOTTE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1101
Mailing Address - Country:US
Mailing Address - Phone:845-825-3502
Mailing Address - Fax:
Practice Address - Street 1:19 CHARLOTTE DR
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1101
Practice Address - Country:US
Practice Address - Phone:845-825-3502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006174174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty