Healthcare Provider Details

I. General information

NPI: 1760375372
Provider Name (Legal Business Name): ELVIA URENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9409 JAMAICA AVE
WOODHAVEN NY
11421-2222
US

IV. Provider business mailing address

9409 JAMAICA AVE
WOODHAVEN NY
11421-2222
US

V. Phone/Fax

Practice location:
  • Phone: 917-932-6830
  • Fax:
Mailing address:
  • Phone: 917-932-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Q00000X
TaxonomyPathology Specialist/Technologist
License NumberAEE1909043
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: