Irena Elbaum

Individual provider Active NPI Home Health Registered Nurse · Pine Bush, NY

NPI 1164622650 · NPPES record last updated Jul 23, 2007

Key facts

NPI
1164622650
Entity type
Individual (NPI type 1)
Primary specialty
Home Health Registered Nurse 163WH0200X
License
246671-1 (NY)
Practice address
618 Awosting Rd
Pine Bush, NY 12566-5570
Phone
(845) 744-5539
NPI assigned
Jul 23, 2007
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
246671-1NYMDHome Health Registered Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Registered Nurse 163WH0200X 246671-1 NY Yes

Addresses

Primary practice location

618 Awosting Rd
Pine Bush, NY 12566-5570

Mailing address

618 Awosting Rd
Pine Bush, NY 12566-5570
Phone (845) 744-5539

Other identifiers

IdentifierTypeStateIssuer
01474684MedicaidNY

Other providers in Pine Bush, NY

All providers in Pine Bush, NY · Home Health Registered Nurse in New York

Sources for this page

Verify at the official NPI Registry.