Healthcare Provider Details

I. General information

NPI: 1619872660
Provider Name (Legal Business Name): ELAINE CAROL HART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W GENESEE ST STE 3
SYRACUSE NY
13204-2329
US

IV. Provider business mailing address

316 OAK ST APT 22
SYRACUSE NY
13203-2947
US

V. Phone/Fax

Practice location:
  • Phone: 315-476-0600
  • Fax: 855-444-8831
Mailing address:
  • Phone: 315-476-0600
  • Fax: 855-444-8831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number297359
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: