MEDICARE: MRS. STORY ELMORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist
2	163W00000X	Registered Nurse	878829	NY

General Provider Information

NPI Number	:	1336522317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STORY ELMORE

Provider Business Mailing Address
First Line	:	8009 CROSS ISLAND PKWY
Second Line	:
City	:	BELLEROSE
State	:	NY
Zip	:	11426-1362
Country	:	US
Telephone Number	:	917-455-1178
Fax Number	:

Provider Business Practice Location Address
First Line	:	265 BROADHOLLOW RD STE 200
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-4833
Country	:	US
Telephone Number	:	917-455-1178
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2015
Last Update Date	:	10/24/2023

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