=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447046578
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELINA NP IN FAMILY HEALTH PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2025
-----------------------------------------------------
Last Update Date | 04/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 274 MADISON AVE RM 601A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-0701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 551-359-6312
-----------------------------------------------------
Fax | 917-994-9580
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 274 MADISON AVE RM 601A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-0701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 551-359-6312
-----------------------------------------------------
Fax | 917-994-9580
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ELINA KIM
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 551-359-6312
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------