Provider Demographics
NPI:1770459489
Name:ELLABBAN, MERVAT (NYS TEACHER)
Entity type:Individual
Prefix:
First Name:MERVAT
Middle Name:
Last Name:ELLABBAN
Suffix:
Gender:F
Credentials:NYS TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 88TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11369-1007
Mailing Address - Country:US
Mailing Address - Phone:646-492-0207
Mailing Address - Fax:
Practice Address - Street 1:2417 88TH ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11369-1007
Practice Address - Country:US
Practice Address - Phone:646-492-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-11
Last Update Date:2025-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1948470251252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency