Provider Demographics
NPI:1083622252
Name:ZUCKER KLEIN, ELANA (PA C)
Entity Type:Individual
Prefix:MRS
First Name:ELANA
Middle Name:
Last Name:ZUCKER KLEIN
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:ELANA
Other - Middle Name:
Other - Last Name:ZUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA C
Mailing Address - Street 1:21 ELLINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977
Mailing Address - Country:US
Mailing Address - Phone:845-362-7353
Mailing Address - Fax:845-782-7926
Practice Address - Street 1:21 ELLINGTON WAY
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977
Practice Address - Country:US
Practice Address - Phone:845-362-7353
Practice Address - Fax:845-782-7926
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0061741363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant