Provider Demographics
NPI:1801004858
Name:MARESCA-ROBERTSON, ELENA L (AUD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:L
Last Name:MARESCA-ROBERTSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 HALLOCK RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3033
Mailing Address - Country:US
Mailing Address - Phone:631-780-4327
Mailing Address - Fax:631-675-6867
Practice Address - Street 1:207 HALLOCK RD
Practice Address - Street 2:SUITE 208
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3033
Practice Address - Country:US
Practice Address - Phone:631-780-4327
Practice Address - Fax:631-675-6867
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001972-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHAA37793OtherHARVARD PILGRAM AUDIOLOGY
NHMA044964Medicare ID - Type Unspecified