Healthcare Provider Details

I. General information

NPI: 1376831339
Provider Name (Legal Business Name): ELANA KOSS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PORT WASHINGTON BLVD. CARDIAC IMAGING
ROSLYN NY
11576-1347
US

IV. Provider business mailing address

POB 1012
PORT WASHINGTON NY
11050-1012
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-4556
  • Fax: 516-622-4551
Mailing address:
  • Phone: 516-629-2469
  • Fax: 516-629-2452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number60 262157
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number262157
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: