Basic Information
| Provider Information | |||||||||
| NPI: | 1851926554 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSENFELD | ||||||||
| FirstName: | ELIANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1264 E 35TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112104822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176137753 | ||||||||
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| Practice Location | |||||||||
| Address1: | 40 ROBERT PITT DR | ||||||||
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| City: | MONSEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109523333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453526800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2020 | ||||||||
| LastUpdateDate: | 07/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 025102 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 025102-01 | 01 | NY | NY STATE LICENSE | OTHER |