Provider Demographics
NPI:1164256285
Name:BETS, ELONA (NP)
Entity type:Individual
Prefix:
First Name:ELONA
Middle Name:
Last Name:BETS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2177 E 21ST ST APT 106
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3664
Mailing Address - Country:US
Mailing Address - Phone:914-510-3390
Mailing Address - Fax:
Practice Address - Street 1:2177 E 21ST ST APT 106
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3664
Practice Address - Country:US
Practice Address - Phone:914-510-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF311987207N00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207N00000XAllopathic & Osteopathic PhysiciansDermatology