Provider Demographics
NPI:1356646368
Name:IDUSERI, ELVIS EKOHLUTORMI (LPN)
Entity Type:Individual
Prefix:MR
First Name:ELVIS
Middle Name:EKOHLUTORMI
Last Name:IDUSERI
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 ADEE AVE
Mailing Address - Street 2:PH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3222
Mailing Address - Country:US
Mailing Address - Phone:718-309-4987
Mailing Address - Fax:
Practice Address - Street 1:1914 ADEE AVE
Practice Address - Street 2:PH
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3222
Practice Address - Country:US
Practice Address - Phone:718-309-4987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-22
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250321-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse