MEDICARE: ELCHANAN TZUR PA-C

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	363A00000X	Physician Assistant	030233	NY

General Provider Information

NPI Number	:	1265218630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELCHANAN TZUR PA-C

Provider Business Mailing Address
First Line	:	1173 E 26TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4608
Country	:	US
Telephone Number	:	917-406-6467
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 HAVEMEYER ST FL 5
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-6288
Country	:	US
Telephone Number	:	212-283-3000
Fax Number	:

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

Provider Enumeration Date	:	09/01/2023
Last Update Date	:	06/12/2024

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