Provider Demographics
NPI:1831240878
Name:RIMLER, ELANA DIANE (PSYD)
Entity type:Individual
Prefix:
First Name:ELANA
Middle Name:DIANE
Last Name:RIMLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 MELROSE RD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5623
Mailing Address - Country:US
Mailing Address - Phone:631-659-5519
Mailing Address - Fax:
Practice Address - Street 1:56 MELROSE RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5623
Practice Address - Country:US
Practice Address - Phone:917-833-5069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016965103TC0700X
NY016965-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02870111Medicaid
NY06102TMedicare PIN