Provider Demographics
NPI:1699023119
Name:ELSIS, KRISTEEN HOPE (MSED)
Entity Type:Individual
Prefix:MS
First Name:KRISTEEN
Middle Name:HOPE
Last Name:ELSIS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:KRISTEEN
Other - Middle Name:
Other - Last Name:GALELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:140 GRASSMERE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1904
Mailing Address - Country:US
Mailing Address - Phone:631-902-7778
Mailing Address - Fax:631-244-5098
Practice Address - Street 1:140 GRASSMERE AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1904
Practice Address - Country:US
Practice Address - Phone:631-902-7778
Practice Address - Fax:631-244-5098
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239546081252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency