Provider Demographics
NPI:1386920312
Name:HAMILTON, ELENA STAR
Entity type:Individual
Prefix:MS
First Name:ELENA
Middle Name:STAR
Last Name:HAMILTON
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 1:32 BELAIR LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3067
Mailing Address - Country:US
Mailing Address - Phone:347-739-4708
Mailing Address - Fax:
Practice Address - Street 1:77 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3757
Practice Address - Country:US
Practice Address - Phone:718-442-7828
Practice Address - Fax:718-720-0762
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator