Basic Information
| Provider Information | |||||||||
| NPI: | 1528366952 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELIE | ||||||||
| FirstName: | JOAS | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 OLD TURNPIKE RD | ||||||||
| Address2: | STE 307 | ||||||||
| City: | NANUET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109542532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456240260 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 OLD TURNPIKE RD | ||||||||
| Address2: | STE 307 | ||||||||
| City: | NANUET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109542532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456240260 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2011 | ||||||||
| LastUpdateDate: | 03/09/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 302589 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
ID Information
| ID | Type | State | Issuer | Description | 302589 | 01 | NY | LICENSED PRACTICAL NURSE | OTHER |