Provider Demographics
NPI:1346013323
Name:MANZOROLHAGH, ELINORA
Entity Type:Individual
Prefix:
First Name:ELINORA
Middle Name:
Last Name:MANZOROLHAGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14707 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2931
Mailing Address - Country:US
Mailing Address - Phone:718-380-0512
Mailing Address - Fax:
Practice Address - Street 1:14128 71ST AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1941
Practice Address - Country:US
Practice Address - Phone:718-350-5408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121709104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker