Healthcare Provider Details

I. General information

NPI: 1386920312
Provider Name (Legal Business Name): MS. ELENA STAR HAMILTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CHICAGO AVE
STATEN ISLAND NY
10305-3757
US

IV. Provider business mailing address

32 BELAIR LN
STATEN ISLAND NY
10305-3067
US

V. Phone/Fax

Practice location:
  • Phone: 718-442-7828
  • Fax: 718-720-0762
Mailing address:
  • Phone: 347-739-4708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: