Provider Demographics
NPI:1093925000
Name:ENG, ELAINE L (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:L
Last Name:ENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 UTOPIA PKWY
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2310
Mailing Address - Country:US
Mailing Address - Phone:718-461-8335
Mailing Address - Fax:
Practice Address - Street 1:3516 UTOPIA PKWY
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2310
Practice Address - Country:US
Practice Address - Phone:718-461-8335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102L00000X
NY1501212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY150121OtherNEW YORK STATE LICENSE
NY150121OtherNEW YORK STATE LICENSE