Provider Demographics
NPI:1851926554
Name:ROSENFELD, ELIANA
Entity Type:Individual
Prefix:
First Name:ELIANA
Middle Name:
Last Name:ROSENFELD
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 1:1264 E 35TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4822
Mailing Address - Country:US
Mailing Address - Phone:917-613-7753
Mailing Address - Fax:
Practice Address - Street 1:40 ROBERT PITT DR
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3333
Practice Address - Country:US
Practice Address - Phone:845-352-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025102363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025102-01OtherNY STATE LICENSE