Healthcare Provider Details

I. General information

NPI: 1386902732
Provider Name (Legal Business Name): ELAINA DELLACAVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 210TH ST
BRONX NY
10467-2402
US

IV. Provider business mailing address

2 RIVER RD
SCARSDALE NY
10583-1110
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-7967
  • Fax: 718-882-3185
Mailing address:
  • Phone: 646-773-0695
  • Fax: 212-746-9292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number277728
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: