MEDICARE: ILANA ETELZON MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number	:	1104428796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILANA ETELZON MD PC

Provider Business Mailing Address
First Line	:	35 WEST END AVENUE
Second Line	:	SUITE 1
City	:	BROOKLYN
State	:	NY
Zip	:	11235
Country	:	US
Telephone Number	:	718-682-3686
Fax Number	:	718-682-3658

Provider Business Practice Location Address
First Line	:	35 WEST END AVENUE
Second Line	:	SUITE 1
City	:	BROOKLYN
State	:	NY
Zip	:	11235
Country	:	US
Telephone Number	:	718-682-3686
Fax Number	:	718-682-3658

Authorized Official
Title or Position	:	MD
Name	:	ILANA ETELZON
Credential	:
Telephone Number	:	718-682-3686

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	05/16/2022

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