Provider Demographics
NPI:1871855619
Name:THALHAMER, ELLEN VIOLA III (MSED, B,CSE)
Entity Type:Individual
Prefix:MISS
First Name:ELLEN
Middle Name:VIOLA
Last Name:THALHAMER
Suffix:III
Gender:F
Credentials:MSED, B,CSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 THAYER PL
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4331
Mailing Address - Country:US
Mailing Address - Phone:631-383-6780
Mailing Address - Fax:
Practice Address - Street 1:11 THAYER PL
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4331
Practice Address - Country:US
Practice Address - Phone:631-383-6780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist