Provider Demographics
NPI:1477909588
Name:HECK, ELENA MARGARET
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:MARGARET
Last Name:HECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:MARGARET
Other - Last Name:KENSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:21 DEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-1003
Mailing Address - Country:US
Mailing Address - Phone:631-644-4342
Mailing Address - Fax:
Practice Address - Street 1:21 DEVILLE DR
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-1003
Practice Address - Country:US
Practice Address - Phone:631-644-4342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY607053163WM0705X
NYF350659-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical