Provider Demographics
NPI:1851868517
Name:GERSTEN, ELANA MICHELLE
Entity Type:Individual
Prefix:
First Name:ELANA
Middle Name:MICHELLE
Last Name:GERSTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELANA
Other - Middle Name:MICHELLE
Other - Last Name:GRANOVITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1206 PLAINVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5134
Mailing Address - Country:US
Mailing Address - Phone:310-956-0049
Mailing Address - Fax:
Practice Address - Street 1:100 E 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1850
Practice Address - Country:US
Practice Address - Phone:212-434-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022901-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant