Healthcare Provider Details

I. General information

NPI: 1194332197
Provider Name (Legal Business Name): E L FAMILY HEALTH NP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 GRAND CONCOURSE
BRONX NY
10456-3901
US

IV. Provider business mailing address

612 CORPORATE WAY STE 2M
VALLEY COTTAGE NY
10989-2027
US

V. Phone/Fax

Practice location:
  • Phone: 718-362-1411
  • Fax: 718-362-1651
Mailing address:
  • Phone: 718-362-8183
  • Fax: 718-362-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ESTHER LEBOVIC
Title or Position: PRESIDENT
Credential: NP
Phone: 718-362-8184