Healthcare Provider Details

I. General information

NPI: 1366554602
Provider Name (Legal Business Name): INNA ELBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 KINGS HWY
BROOKLYN NY
11223-1615
US

IV. Provider business mailing address

2661 W 2ND ST APT 5D
BROOKLYN NY
11223-6360
US

V. Phone/Fax

Practice location:
  • Phone: 718-336-0200
  • Fax: 718-336-2758
Mailing address:
  • Phone: 718-934-5067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number002748
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: