Provider Demographics
NPI:1154055564
Name:BILANISHVILI, ELZA (AGPCNP)
Entity Type:Individual
Prefix:
First Name:ELZA
Middle Name:
Last Name:BILANISHVILI
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SURF AVE APT 3G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3504
Mailing Address - Country:US
Mailing Address - Phone:347-358-6869
Mailing Address - Fax:
Practice Address - Street 1:501 SURF AVE APT 3G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-3504
Practice Address - Country:US
Practice Address - Phone:347-358-6869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309990363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health