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General NPI Number Information
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NPI Number | 1831640440
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Entity Type | Individual
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Provider Name | ELANA RADIN PA
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Gender | Female
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Dates
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Enumeration Date | 10/18/2016
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 6 WELLNESS WAY STE G03
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City | LATHAM
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State | NY
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Zip | 12110-2135
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Country | US
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Telephone | 518-785-5884
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Fax | 518-783-6890
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Provider Business Mailing Address
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Address Line | 6 WELLNESS WAY STE 201
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City | LATHAM
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State | NY
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Zip | 12110-2156
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Country | US
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Telephone | 518-782-3700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 020274
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License Number State | NY
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