Healthcare Provider Details

I. General information

NPI: 1275600116
Provider Name (Legal Business Name): ELENA ERIKA GAZZOLA-KRAENZLIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E BOSTON POST RD
MAMARONECK NY
10543-3741
US

IV. Provider business mailing address

620 E BOSTON POST RD
MAMARONECK NY
10543-3741
US

V. Phone/Fax

Practice location:
  • Phone: 914-777-5437
  • Fax:
Mailing address:
  • Phone: 914-777-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number215407
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number040193
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: