Provider Demographics
NPI:1164423901
Name:ATHANAIL, ELLEN M (DC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:ATHANAIL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 BAY RIDGE PKWY
Mailing Address - Street 2:SUITE #1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2452
Mailing Address - Country:US
Mailing Address - Phone:718-921-5191
Mailing Address - Fax:
Practice Address - Street 1:268 BAY RIDGE PKWY
Practice Address - Street 2:SUITE #1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2452
Practice Address - Country:US
Practice Address - Phone:718-921-5191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0059321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11-3023392OtherEMPIRE BLUE CROSS
NY11-3023392OtherASHN
NY456269OtherAETNA
NY11-3023392OtherUNITED HEALTHCARE
NY11-3023392OtherGHI
NY0740341OtherCIGNA
NYP414897OtherOXFORD
NY11-3023392OtherACN
NY456269OtherAETNA
NYX36441Medicare ID - Type UnspecifiedMEDICARE ID