Provider Demographics
NPI:1083954523
Name:KHALFIN ELBAZ, ELISHEVA ROSE (MS, BSN, RN)
Entity type:Individual
Prefix:
First Name:ELISHEVA
Middle Name:ROSE
Last Name:KHALFIN ELBAZ
Suffix:
Gender:U
Credentials:MS, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-4636
Mailing Address - Country:US
Mailing Address - Phone:267-608-8788
Mailing Address - Fax:
Practice Address - Street 1:4601 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-4636
Practice Address - Country:US
Practice Address - Phone:267-608-8788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN776960163W00000X, 163W00000X
172V00000X, 174H00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula