Provider Demographics
NPI:1952301855
Name:DREXLER, ELLEN DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:DIANE
Last Name:DREXLER
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 1:883 65TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4737
Mailing Address - Country:US
Mailing Address - Phone:718-283-5850
Mailing Address - Fax:718-635-6082
Practice Address - Street 1:883 65TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4737
Practice Address - Country:US
Practice Address - Phone:718-283-5850
Practice Address - Fax:718-635-6082
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1384532084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00709760Medicaid
NY00709760Medicaid
NY64A85300Medicare ID - Type Unspecified