Healthcare Provider Details

I. General information

NPI: 1679619399
Provider Name (Legal Business Name): BETH KORBY ELENKO PHD, OTL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS BETH ANDREA KORBY

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 GEORGIA LN
PLAINVIEW NY
11803-3803
US

IV. Provider business mailing address

9 GEORGIA LN
PLAINVIEW NY
11803-3803
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-7737
  • Fax: 718-270-7464
Mailing address:
  • Phone: 718-281-4470
  • Fax: 718-281-1048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number006483-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: