Provider Demographics
NPI:1457686867
Name:ELYA, DANA A (RD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:A
Last Name:ELYA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:A
Other - Last Name:LILIENTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:67 COLGATE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1501
Mailing Address - Country:US
Mailing Address - Phone:347-420-7905
Mailing Address - Fax:
Practice Address - Street 1:67 COLGATE RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1501
Practice Address - Country:US
Practice Address - Phone:347-420-7905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-03
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
866213133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered