Individual
ELLENA BAVARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2811 QUEENS PLZ N, LONG ISLAND CITY, NY 11101-4008
(718) 391-8300
Mailing address
142 SHIEL AVE, STATEN ISLAND, NY 10309-4280
(718) 757-4817
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
456565
NY
Other
Enumeration date
10/02/2015
Last updated
10/02/2015
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