Provider Demographics
NPI:1801379995
Name:MEZZASALMA, ELAINA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ELAINA
Middle Name:
Last Name:MEZZASALMA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CHASE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-2102
Mailing Address - Country:US
Mailing Address - Phone:908-907-6941
Mailing Address - Fax:
Practice Address - Street 1:670 6TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6800
Practice Address - Country:US
Practice Address - Phone:718-369-2560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01796400225100000X
NY043553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist