Healthcare Provider Details

I. General information

NPI: 1578077152
Provider Name (Legal Business Name): ELLEN MIZRAHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2017
Last Update Date: 11/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 KINGS HWY
BROOKLYN NY
11223-2003
US

IV. Provider business mailing address

1525 E 3RD ST
BROOKLYN NY
11230-6327
US

V. Phone/Fax

Practice location:
  • Phone: 718-627-1145
  • Fax:
Mailing address:
  • Phone: 917-576-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number036952-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: