Provider Demographics
NPI:1336248483
Name:ELNER, IRINA (PA)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:ELNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 E HENRIETTA RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4629
Mailing Address - Country:US
Mailing Address - Phone:585-760-5466
Mailing Address - Fax:585-760-5467
Practice Address - Street 1:2021 WINTON RD S
Practice Address - Street 2:JEWISH HOME OF ROCHESTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-760-5466
Practice Address - Fax:585-760-5467
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8512363AM0700X
NY008512363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02816195Medicaid
NYDD1103Medicare PIN
NYJ400090469/GRP70008AMedicare PIN
NY02816195Medicaid