MEDICARE: ELANA KRAM

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	225100000X	Physical Therapist	039272-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	039272-1	OTHER	NY	LICENS#

General Provider Information

NPI Number	:	1316315310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELANA KRAM

Provider Business Mailing Address
First Line	:	17619 JEWEL AVE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11365-3444
Country	:	US
Telephone Number	:	845-596-6620
Fax Number	:

Provider Business Practice Location Address
First Line	:	17619 JEWEL AVE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11365-3444
Country	:	US
Telephone Number	:	845-596-6620
Fax Number	:

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

Provider Enumeration Date	:	09/08/2015
Last Update Date	:	09/08/2015

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Directions to “ ELANA KRAM ” Practice Location

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