Provider Demographics
NPI:1164534749
Name:ADLER, ELISA P
Entity Type:Individual
Prefix:DR
First Name:ELISA
Middle Name:P
Last Name:ADLER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ELISA
Other - Middle Name:P
Other - Last Name:ADLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:242 W BAY DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1940
Mailing Address - Country:US
Mailing Address - Phone:516-431-9066
Mailing Address - Fax:516-431-0904
Practice Address - Street 1:242 W BAY DR
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-1940
Practice Address - Country:US
Practice Address - Phone:516-431-9066
Practice Address - Fax:516-431-0904
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX30561Medicare ID - Type UnspecifiedCHIROPRACTIC