Provider Demographics
NPI:1366554602
Name:ELBERT, INNA
Entity type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:ELBERT
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 1:2661 W 2ND ST APT 5D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-6360
Mailing Address - Country:US
Mailing Address - Phone:718-934-5067
Mailing Address - Fax:
Practice Address - Street 1:391 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1615
Practice Address - Country:US
Practice Address - Phone:718-336-0200
Practice Address - Fax:718-336-2758
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002748171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist