Healthcare Provider Details

I. General information

NPI: 1467070029
Provider Name (Legal Business Name): ELECTRA HEALTH MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 GREENE AVE 7B
BROOKLYN NY
11238
US

IV. Provider business mailing address

75 GREENE AVE APT 7B
BROOKLYN NY
11238-6789
US

V. Phone/Fax

Practice location:
  • Phone: 646-760-6669
  • Fax:
Mailing address:
  • Phone: 646-760-6669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JANNINE VERSI
Title or Position: COO
Credential:
Phone: 202-524-8706