Provider Demographics
NPI:1922188994
Name:DREYHAUPT, ELEANOR C (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:C
Last Name:DREYHAUPT
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:79-01 BROADWAY
Mailing Address - Street 2:CARDIOLOGY, D4-54
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1329
Mailing Address - Country:US
Mailing Address - Phone:718-334-2975
Mailing Address - Fax:718-334-5990
Practice Address - Street 1:79-01 BROADWAY
Practice Address - Street 2:CARDIOLOGY, D4-54
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-2975
Practice Address - Fax:718-334-5990
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333622363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00330128Medicare ID - Type Unspecified