1679619399 NPI number — DR. BETH KORBY ELENKO PHD, OTL

Table of content: DR. BETH KORBY ELENKO PHD, OTL (NPI 1679619399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679619399 NPI number — DR. BETH KORBY ELENKO PHD, OTL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELENKO
Provider First Name:
BETH
Provider Middle Name:
KORBY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, OTL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KORBY
Provider Other First Name:
BETH
Provider Other Middle Name:
ANDREA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679619399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 GEORGIA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINVIEW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11803-3803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-281-4470
Provider Business Mailing Address Fax Number:
718-281-1048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 GEORGIA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVIEW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11803-3803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-270-7737
Provider Business Practice Location Address Fax Number:
718-270-7464
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  006483-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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