Healthcare Provider Details

I. General information

NPI: 1184722548
Provider Name (Legal Business Name): ELENA SANDERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SEAVIEW AVE
STATEN ISLAND NY
10305-2216
US

IV. Provider business mailing address

400 SEAVIEW AVE
STATEN ISLAND NY
10305-2216
US

V. Phone/Fax

Practice location:
  • Phone: 718-980-0055
  • Fax: 718-980-0058
Mailing address:
  • Phone: 718-980-0055
  • Fax: 718-980-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number240200
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: