Provider Demographics
NPI:1437214756
Name:ELANT AT GOSHEN INC
Entity Type:Organization
Organization Name:ELANT AT GOSHEN INC
Other - Org Name:ELANT AT HOME STORE
Other - Org Type:Other Name
Authorized Official - Title/Position:VP COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:ANNMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COVONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-291-3759
Mailing Address - Street 1:46 HARRIMAN DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-2410
Mailing Address - Country:US
Mailing Address - Phone:845-291-3759
Mailing Address - Fax:845-291-3833
Practice Address - Street 1:31 CERONE PL
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5104
Practice Address - Country:US
Practice Address - Phone:845-291-3759
Practice Address - Fax:845-291-3833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0635010001Medicare ID - Type Unspecified