Provider Demographics
NPI:1932641321
Name:ELMHURST SERVICES, INC
Entity Type:Organization
Organization Name:ELMHURST SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVANS
Authorized Official - Middle Name:
Authorized Official - Last Name:CREVECOEUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-354-6810
Mailing Address - Street 1:565 CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3519
Mailing Address - Country:US
Mailing Address - Phone:718-433-0044
Mailing Address - Fax:718-433-4644
Practice Address - Street 1:9422 59TH AVE STE E1
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5151
Practice Address - Country:US
Practice Address - Phone:718-433-0044
Practice Address - Fax:718-433-4644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty