Healthcare Provider Details

I. General information

NPI: 1427684570
Provider Name (Legal Business Name): ELENA ROSE BRANDHOFER HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AARON CT
KINGSTON NY
12401-2934
US

IV. Provider business mailing address

400 AARON CT
KINGSTON NY
12401-2934
US

V. Phone/Fax

Practice location:
  • Phone: 845-443-3365
  • Fax: 845-520-2668
Mailing address:
  • Phone: 845-443-3365
  • Fax: 845-520-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number14000057872
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: