Healthcare Provider Details

I. General information

NPI: 1639504921
Provider Name (Legal Business Name): ELEANORE ELIZABETH EGAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 FLATBUSH AVENUE EXT
BROOKLYN NY
11201-2903
US

IV. Provider business mailing address

40 FLATBUSH AVENUE EXT
BROOKLYN NY
11201-2903
US

V. Phone/Fax

Practice location:
  • Phone: 212-271-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number026234
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA031144
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: