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General NPI Number Information
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NPI Number | 1104428796
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Entity Type | Organization
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Legal Business Name | ILANA ETELZON MD PC
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Dates
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Enumeration Date | 11/10/2020
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Last Update Date | 05/16/2022
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Provider Practice Location Address
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Address Line | 35 WEST END AVENUE SUITE 1
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City | BROOKLYN
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State | NY
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Zip | 11235
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Country | US
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Telephone | 718-682-3686
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Fax | 718-682-3658
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Provider Business Mailing Address
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Address Line | 35 WEST END AVENUE SUITE 1
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City | BROOKLYN
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State | NY
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Zip | 11235
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Country | US
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Telephone | 718-682-3686
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Fax | 718-682-3658
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Authorized Official
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Title or Position | MD
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Name | ILANA ETELZON
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Credential |
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Telephone | 718-682-3686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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