Provider Demographics
NPI:1336103936
Name:OCFEMIA, ELLENE CONANAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELLENE
Middle Name:CONANAN
Last Name:OCFEMIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ELLENE
Other - Middle Name:LACHICA
Other - Last Name:CONANAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10132 97TH ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2511
Mailing Address - Country:US
Mailing Address - Phone:171-873-8343
Mailing Address - Fax:718-738-3438
Practice Address - Street 1:6865 FRESH POND RD
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5263
Practice Address - Country:US
Practice Address - Phone:171-836-6083
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02713519Medicaid
NYQ46966Medicare UPIN
NY07201Medicare ID - Type UnspecifiedMEDICARE, QUEENS, NY