Healthcare Provider Details

I. General information

NPI: 1962320622
Provider Name (Legal Business Name): ELISE KRUPOFF OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11718 ROCKAWAY BEACH BLVD
ROCKAWAY PARK NY
11694-2018
US

IV. Provider business mailing address

1402 AVENUE Y
BROOKLYN NY
11235-3907
US

V. Phone/Fax

Practice location:
  • Phone: 718-634-5808
  • Fax:
Mailing address:
  • Phone: 347-370-2629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011394
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: