Healthcare Provider Details

I. General information

NPI: 1205091436
Provider Name (Legal Business Name): ELAINE M TRENTACOSTA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 BROADCAST PLZ
MERRICK NY
11566-3461
US

IV. Provider business mailing address

91-31 QUEENS BLVD.
ELMHURST NY
11373
US

V. Phone/Fax

Practice location:
  • Phone: 516-546-8000
  • Fax: 516-868-7394
Mailing address:
  • Phone: 718-779-7000
  • Fax: 718-458-5379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number464769
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: