Provider Demographics
NPI:1518161611
Name:VERNESCU, ELENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:VERNESCU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 GRAND CONCOURSE
Mailing Address - Street 2:APT. 2R
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-2814
Mailing Address - Country:US
Mailing Address - Phone:718-402-7377
Mailing Address - Fax:718-402-7377
Practice Address - Street 1:860 GRAND CONCOURSE
Practice Address - Street 2:APT. 2R
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-2814
Practice Address - Country:US
Practice Address - Phone:718-402-7377
Practice Address - Fax:718-402-7377
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0341751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00580841Medicaid
NY31062 86 P1OtherGHI