MEDICARE: DR. ELENA SANDERS M.D.

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	207RR0500X	Rheumatology Physician	240200	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184722548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELENA SANDERS M.D.

Provider Business Mailing Address
First Line	:	400 SEAVIEW AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2216
Country	:	US
Telephone Number	:	718-980-0055
Fax Number	:	718-980-0058

Provider Business Practice Location Address
First Line	:	400 SEAVIEW AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2216
Country	:	US
Telephone Number	:	718-980-0055
Fax Number	:	718-980-0058

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/03/2013

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