MEDICARE: MS. ELANA BIRNBERG N.P.

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	363LA2200X	Adult Health Nurse Practitioner	F-305330-1	NY

General Provider Information

NPI Number	:	1316250079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELANA BIRNBERG N.P.

Provider Business Mailing Address
First Line	:	273 MAIN ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10307-1723
Country	:	US
Telephone Number	:	718-689-3686
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 55TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2559
Country	:	US
Telephone Number	:	718-630-6369
Fax Number	:

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

Provider Enumeration Date	:	07/22/2010
Last Update Date	:	07/22/2010

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