Provider Demographics
NPI:1063665123
Name:STEIN, ELISSA L
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:L
Last Name:STEIN
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 1:3051 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5204
Mailing Address - Country:US
Mailing Address - Phone:516-546-5571
Mailing Address - Fax:631-969-1250
Practice Address - Street 1:3051 SHORE DR
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-5204
Practice Address - Country:US
Practice Address - Phone:516-546-5571
Practice Address - Fax:631-969-1250
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-02
Last Update Date:2008-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005997235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist