Healthcare Provider Details

I. General information

NPI: 1821992157
Provider Name (Legal Business Name): KRISTIN ELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6260 60TH AVE
MASPETH NY
11378-3425
US

IV. Provider business mailing address

6260 60TH AVE
MASPETH NY
11378-3425
US

V. Phone/Fax

Practice location:
  • Phone: 646-709-4720
  • Fax:
Mailing address:
  • Phone: 646-709-4720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number745925
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: