Provider Demographics
NPI:1659642155
Name:RESUELLO, ELISA BAUN (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:BAUN
Last Name:RESUELLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 DELONG AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-1335
Mailing Address - Country:US
Mailing Address - Phone:347-697-5411
Mailing Address - Fax:
Practice Address - Street 1:140 DELONG AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-1335
Practice Address - Country:US
Practice Address - Phone:347-697-5411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist