Provider Demographics
NPI:1467854117
Name:ISRAILOVA, ELEONORA
Entity Type:Individual
Prefix:
First Name:ELEONORA
Middle Name:
Last Name:ISRAILOVA
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 1:9602 57TH AVE APT 6M
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3427
Mailing Address - Country:US
Mailing Address - Phone:917-676-3801
Mailing Address - Fax:
Practice Address - Street 1:9602 57TH AVE APT 6M
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3427
Practice Address - Country:US
Practice Address - Phone:917-676-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1377696174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist