Provider Demographics
NPI:1902346984
Name:PELCOVITZ-WOLF, ELANA C (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELANA
Middle Name:C
Last Name:PELCOVITZ-WOLF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:ELANA
Other - Middle Name:C
Other - Last Name:PELCOVITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:20 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1717
Mailing Address - Country:US
Mailing Address - Phone:516-660-2556
Mailing Address - Fax:
Practice Address - Street 1:20 BEECHWOOD DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1717
Practice Address - Country:US
Practice Address - Phone:516-660-2556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF308121-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health