MEDICARE: ELLEN CHELNITSKY D.O.

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	207R00000X	Internal Medicine Physician	280614	NY

General Provider Information

NPI Number	:	1164785390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN CHELNITSKY D.O.

Provider Business Mailing Address
First Line	:	133A W END AVE STE 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4808
Country	:	US
Telephone Number	:	718-891-1300
Fax Number	:	718-891-1301

Provider Business Practice Location Address
First Line	:	133A W END AVE STE 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4808
Country	:	US
Telephone Number	:	718-891-1300
Fax Number	:	718-891-1301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	08/24/2020

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