Provider Demographics
NPI:1750864328
Name:ELENTO, NOEL
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:ELENTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 FRANKLIN PL APT 5
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1150
Mailing Address - Country:US
Mailing Address - Phone:516-567-7033
Mailing Address - Fax:
Practice Address - Street 1:224 FRANKLIN PL APT 5
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1150
Practice Address - Country:US
Practice Address - Phone:516-567-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist