Provider Demographics
NPI:1396082699
Name:ATLAS, ELINA (AUD)
Entity type:Individual
Prefix:
First Name:ELINA
Middle Name:
Last Name:ATLAS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ELINA
Other - Middle Name:
Other - Last Name:ATLAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:250 CEDRUS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4515
Mailing Address - Country:US
Mailing Address - Phone:917-609-6194
Mailing Address - Fax:
Practice Address - Street 1:40 W BRIGHTON AVE STE 103
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4901
Practice Address - Country:US
Practice Address - Phone:917-609-6194
Practice Address - Fax:718-996-1123
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001763231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02619872Medicaid