Healthcare Provider Details

I. General information

NPI: 1215693676
Provider Name (Legal Business Name): ELENA OFFERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 03/23/2024
Certification Date: 03/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W 40TH ST RM 403
NEW YORK NY
10018-2045
US

IV. Provider business mailing address

202 W 40TH ST RM 403
NEW YORK NY
10018-2045
US

V. Phone/Fax

Practice location:
  • Phone: 917-382-0333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number002843
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: