Healthcare Provider Details

I. General information

NPI: 1265218630
Provider Name (Legal Business Name): ELCHANAN TZUR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 HAVEMEYER ST FL 5
BROOKLYN NY
11211-6288
US

IV. Provider business mailing address

1173 E 26TH ST
BROOKLYN NY
11210-4608
US

V. Phone/Fax

Practice location:
  • Phone: 212-283-3000
  • Fax:
Mailing address:
  • Phone: 917-406-6467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number030233
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: