Provider Demographics
NPI:1932794781
Name:KLINOVA, ELENA (MS ED)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:KLINOVA
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3744
Mailing Address - Country:US
Mailing Address - Phone:347-935-1191
Mailing Address - Fax:
Practice Address - Street 1:547 WILSON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3744
Practice Address - Country:US
Practice Address - Phone:347-935-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist