Provider Demographics
NPI:1578824603
Name:RENTA, ELSIE M (MS ED)
Entity Type:Individual
Prefix:MS
First Name:ELSIE
Middle Name:M
Last Name:RENTA
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:LAKE ARIEL
Mailing Address - State:PA
Mailing Address - Zip Code:18436-0103
Mailing Address - Country:US
Mailing Address - Phone:917-478-8417
Mailing Address - Fax:
Practice Address - Street 1:1520 LEDGEDALE RD
Practice Address - Street 2:
Practice Address - City:LAKE ARIEL
Practice Address - State:PA
Practice Address - Zip Code:18436-5590
Practice Address - Country:US
Practice Address - Phone:917-478-8417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1846740174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist