Provider Demographics
NPI:1821351305
Name:WELLER, ELAINE PATRICIA (BS, MS ED)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:PATRICIA
Last Name:WELLER
Suffix:
Gender:F
Credentials:BS, MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-4305
Mailing Address - Country:US
Mailing Address - Phone:212-787-9700
Mailing Address - Fax:
Practice Address - Street 1:535 8TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4305
Practice Address - Country:US
Practice Address - Phone:212-787-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1816945174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1816945OtherDEPARTMENT OF EDUCATION