MEDICARE: DR. ILANA ETELZON M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program		NY
2	208100000X	Physical Medicine & Rehabilitation Physician	297666	NY

General Provider Information

NPI Number	:	1730471814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ILANA ETELZON M.D.

Provider Business Mailing Address
First Line	:	35 WEST END AVENUE
Second Line	:	SUITE 1
City	:	BROOKLYN
State	:	NY
Zip	:	11235
Country	:	US
Telephone Number	:	718-682-3686
Fax Number	:	718-682-3658

Provider Business Practice Location Address
First Line	:	35 WEST END AVENUE
Second Line	:	SUITE 1
City	:	BROOKLYN
State	:	NY
Zip	:	11235
Country	:	US
Telephone Number	:	718-682-3686
Fax Number	:	718-682-3658

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

Provider Enumeration Date	:	05/09/2011
Last Update Date	:	05/16/2022

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