Basic Information
| Provider Information | |||||||||
| NPI: | 1811162563 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TREJO | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | ELENA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RPA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3003 NEW HYDE PARK RD STE 401 | ||||||||
| Address2: | |||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110421214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162242400 | ||||||||
| FaxNumber: | 5162242461 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 EAST 68TH ROOM, M-528 | ||||||||
| Address2: | DEPT. OF MEDICINE, BOX 130 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127464209 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2008 | ||||||||
| LastUpdateDate: | 10/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 05034-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.