Provider Demographics
NPI:1225305451
Name:ELEBY, MINNIE
Entity Type:Individual
Prefix:MS
First Name:MINNIE
Middle Name:
Last Name:ELEBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MINNIE
Other - Middle Name:ELEBY
Other - Last Name:BERKLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2173 DAVIDSON AVE.
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453
Mailing Address - Country:US
Mailing Address - Phone:347-879-7272
Mailing Address - Fax:
Practice Address - Street 1:2173 DAVIDSON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453
Practice Address - Country:US
Practice Address - Phone:347-879-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY522423-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse