Individual
ELISE MCKENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
530 1ST AVE STE 10W, NEW YORK, NY 10016-6402
(212) 263-7391
Mailing address
530 1ST AVE STE 10W, NEW YORK, NY 10016-6402
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD047525
DC
2086S0120X
Pediatric Surgery Physician
Primary
325457
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
CT
Other
Enumeration date
05/02/2014
Last updated
12/18/2023
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