Provider Demographics
NPI:1215647037
Name:ELISHEVA TRATNER NURSE PRACTITIONER IN ADULT HEALTH PLLC
Entity type:Organization
Organization Name:ELISHEVA TRATNER NURSE PRACTITIONER IN ADULT HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELISHEVA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRATNER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:917-502-6482
Mailing Address - Street 1:654 NUTLEY PL
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:654 NUTLEY PL
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3028
Practice Address - Country:US
Practice Address - Phone:917-502-6482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF309044-1OtherNURSE PRACTITIONER LIC