Provider Demographics
NPI:1811229347
Name:NASSOIY, ELISA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:ELISA
Middle Name:LYNN
Last Name:NASSOIY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 CAYUGA DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1850
Mailing Address - Country:US
Mailing Address - Phone:716-754-7159
Mailing Address - Fax:
Practice Address - Street 1:101 LANG BLVD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-1601
Practice Address - Country:US
Practice Address - Phone:716-774-0442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor