Provider Demographics
NPI:1760852156
Name:RICHARDS, ELISE N
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:N
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 E 20TH ST
Mailing Address - Street 2:APT MB
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-8120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:442 E 20TH ST
Practice Address - Street 2:APT MB
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-8120
Practice Address - Country:US
Practice Address - Phone:718-986-9975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401899363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health