Individual
ELAINE DE LA ROSA JEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
10504 SUTPHIN BLVD, JAMAICA, NY 11435-5022
(855) 681-8700
Mailing address
10504 SUTPHIN BLVD, JAMAICA, NY 11435-5022
(855) 681-8700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
030292
NY
207QA0505X
Adult Medicine Physician
030292
NY
363A00000X
Physician Assistant
030292
NY
Other
Enumeration date
08/07/2023
Last updated
09/28/2023
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