Provider Demographics
NPI:1760662415
Name:WOODHOUSE, ELENA A
Entity Type:Individual
Prefix:MISS
First Name:ELENA
Middle Name:A
Last Name:WOODHOUSE
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 1:1690 METROPOLITAN AVE
Mailing Address - Street 2:7 - E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6970
Mailing Address - Country:US
Mailing Address - Phone:718-829-8899
Mailing Address - Fax:
Practice Address - Street 1:1690 METROPOLITAN AVE
Practice Address - Street 2:7 - E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-6970
Practice Address - Country:US
Practice Address - Phone:718-829-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-10
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209518164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02913528Medicaid