Provider Demographics
NPI:1396195178
Name:ELDER, JOSEPH DAVID (MA, LMT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DAVID
Last Name:ELDER
Suffix:
Gender:M
Credentials:MA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 W 57TH ST
Mailing Address - Street 2:#609
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1701
Mailing Address - Country:US
Mailing Address - Phone:917-843-8609
Mailing Address - Fax:
Practice Address - Street 1:457 W 57TH ST
Practice Address - Street 2:#609
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1701
Practice Address - Country:US
Practice Address - Phone:917-843-8609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003329172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist