Provider Demographics
NPI:1144764168
Name:ELIACH, JAYNE (RN, MS CERTIFIED CLI)
Entity type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:
Last Name:ELIACH
Suffix:
Gender:F
Credentials:RN, MS CERTIFIED CLI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 WEST END AVENUE
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:212-721-7211
Mailing Address - Fax:
Practice Address - Street 1:470 WEST END AVENUE
Practice Address - Street 2:SUITE 1D
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-721-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297325364SP0807X, 364SP0809X, 364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family