Provider Demographics
NPI:1477846814
Name:SMOLEN, ELAINE R (MAT)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:R
Last Name:SMOLEN
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 E 72ND ST
Mailing Address - Street 2:APT 2E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4628
Mailing Address - Country:US
Mailing Address - Phone:201-452-1210
Mailing Address - Fax:
Practice Address - Street 1:80 EAST END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-8004
Practice Address - Country:US
Practice Address - Phone:212-585-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY420427101235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist