Provider Demographics
NPI:1326392721
Name:KLIMCHUCK, ELAINA CAROLINE (MD)
Entity Type:Individual
Prefix:
First Name:ELAINA
Middle Name:CAROLINE
Last Name:KLIMCHUCK
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 1:85-31 120TH
Mailing Address - Street 2:APT 4D
Mailing Address - City:KEW GARDENS
Mailing Address - State:PA
Mailing Address - Zip Code:11415
Mailing Address - Country:US
Mailing Address - Phone:585-733-2200
Mailing Address - Fax:
Practice Address - Street 1:75-25 WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427
Practice Address - Country:US
Practice Address - Phone:718-464-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3101292084P0800X
NY2812152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry