Healthcare Provider Details

I. General information

NPI: 1609260025
Provider Name (Legal Business Name): ELENA O'ROURKE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 5TH AVE
NEW YORK NY
10029-6503
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL BOX 3000
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-3300
  • Fax: 646-537-8610
Mailing address:
  • Phone: 212-987-3100
  • Fax: 212-731-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number643958
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number339972
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: