MEDICARE: ELENA SANDERS, MD, P.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	261QM2500X	Medical Specialty Clinic/Center	240200	NY

General Provider Information

NPI Number	:	1780943845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELENA SANDERS, MD, P.C.

Provider Business Mailing Address
First Line	:	2781 OCEAN AVE APT 3L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4727
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	:	PRESIDENT
Name	:	ELENA SANDERS
Credential	:	MD
Telephone Number	:	718-980-0055

Provider Enumeration Date	:	05/10/2012
Last Update Date	:	07/03/2013

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