Provider Demographics
NPI:1225391204
Name:ELIA, JENNIFER (MA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:ELIA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10784 SWEET CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-4098
Mailing Address - Country:US
Mailing Address - Phone:914-645-8862
Mailing Address - Fax:
Practice Address - Street 1:10080 E 121ST ST STE 112
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-4211
Practice Address - Country:US
Practice Address - Phone:317-813-1780
Practice Address - Fax:317-813-3012
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-24
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY656482174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist