Provider Demographics
NPI:1932141280
Name:KLIMENKO, ELENA (MD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:KLIMENKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MADISON AVE
Mailing Address - Street 2:#905
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0801
Mailing Address - Country:US
Mailing Address - Phone:212-696-4325
Mailing Address - Fax:212-696-4328
Practice Address - Street 1:280 MADISON AVE
Practice Address - Street 2:SUITE 905
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0801
Practice Address - Country:US
Practice Address - Phone:212-696-4325
Practice Address - Fax:212-696-4328
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02423641Medicaid
NY95S0923361Medicare ID - Type Unspecified
NY02423641Medicaid