Provider Demographics
NPI:1275680613
Name:BARANOV, ELENA (RPH)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:BARANOV
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 ALTER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3923
Mailing Address - Country:US
Mailing Address - Phone:917-415-7770
Mailing Address - Fax:212-348-3868
Practice Address - Street 1:56 7TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6672
Practice Address - Country:US
Practice Address - Phone:212-255-6100
Practice Address - Fax:212-255-6112
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02575200183500000X
NY047177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist