Active NPI
Elana Shalom, PA
- Physician Assistant
- Forest Hills, NY
National Provider Identifier
1245639699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 017888
- Practice address
- 7064 Yellowstone Blvd
Forest Hills, NY 11375-3563 - Phone
- (718) 355-9962
- NPI assigned
- Aug 21, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 017888 | NY | Primary |
Addresses
Primary practice location
7064 Yellowstone Blvd
Forest Hills, NY 11375-3563
Mailing address
7064 Yellowstone Blvd
Forest Hills, NY 11375-3563
Phone (718) 355-9962
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 017888 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 017888 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478563200000",
"number": "1245639699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7064 YELLOWSTONE BLVD",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113753563",
"telephone_number": "718-355-9962"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7064 YELLOWSTONE BLVD",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113753563",
"telephone_number": "718-355-9962"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHALOM",
"first_name": "ELANA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-21",
"last_updated": "2016-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "017888",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "017888",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Forest Hills, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.