Provider Demographics
NPI:1194268706
Name:INGENITO, ELENA
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:INGENITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 101ST ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1109
Mailing Address - Country:US
Mailing Address - Phone:718-846-0454
Mailing Address - Fax:718-846-1171
Practice Address - Street 1:8440 101ST ST
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1109
Practice Address - Country:US
Practice Address - Phone:718-846-0454
Practice Address - Fax:718-846-1171
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011353-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist