Provider Demographics
NPI:1861471195
Name:EDEL, ELISA (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:EDEL
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
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Mailing Address - Street 1:257 BEACH 128TH STREET
Mailing Address - Street 2:#4B
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694
Mailing Address - Country:US
Mailing Address - Phone:718-318-1427
Mailing Address - Fax:718-270-1438
Practice Address - Street 1:451 CLARKSON AVENUE
Practice Address - Street 2:N BLDG RM 311 KINGS COUNTY HOSPITAL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-245-2739
Practice Address - Fax:718-270-1438
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0085811235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist