Provider Demographics
NPI:1467990382
Name:ELTING, KAREN (LMT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:ELTING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 REGAL RD
Mailing Address - Street 2:
Mailing Address - City:STUYVESANT
Mailing Address - State:NY
Mailing Address - Zip Code:12173-1614
Mailing Address - Country:US
Mailing Address - Phone:845-943-8213
Mailing Address - Fax:
Practice Address - Street 1:7 REGAL RD
Practice Address - Street 2:
Practice Address - City:STUYVESANT
Practice Address - State:NY
Practice Address - Zip Code:12173-1614
Practice Address - Country:US
Practice Address - Phone:845-417-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-11
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029602225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist