Provider Demographics
NPI:1790424513
Name:MENASHEROV, ORLY ELINOR
Entity Type:Individual
Prefix:DR
First Name:ORLY
Middle Name:ELINOR
Last Name:MENASHEROV
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 1:10250 62ND RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1056
Mailing Address - Country:US
Mailing Address - Phone:347-596-6670
Mailing Address - Fax:
Practice Address - Street 1:10250 62ND RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1056
Practice Address - Country:US
Practice Address - Phone:347-596-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist