Provider Demographics
NPI:1417103029
Name:COHEN-ROTH, ELISSA D (LPN)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:D
Last Name:COHEN-ROTH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CRESCENT LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-2506
Mailing Address - Country:US
Mailing Address - Phone:516-939-2229
Mailing Address - Fax:516-939-2252
Practice Address - Street 1:1074 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4918
Practice Address - Country:US
Practice Address - Phone:516-939-2229
Practice Address - Fax:516-939-2252
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149644164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse