Provider Demographics
NPI:1841766854
Name:ELENIS, KATERINA (CERTIFIED)
Entity Type:Individual
Prefix:
First Name:KATERINA
Middle Name:
Last Name:ELENIS
Suffix:
Gender:F
Credentials:CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8029 255TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1215
Mailing Address - Country:US
Mailing Address - Phone:646-208-5858
Mailing Address - Fax:
Practice Address - Street 1:8029 255TH ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004-1215
Practice Address - Country:US
Practice Address - Phone:646-208-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1223582181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist