Provider Demographics
NPI:1922340777
Name:GROTTO LUDWIG, ELISA
Entity Type:Individual
Prefix:MS
First Name:ELISA
Middle Name:
Last Name:GROTTO LUDWIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-1411
Mailing Address - Country:US
Mailing Address - Phone:914-462-7063
Mailing Address - Fax:
Practice Address - Street 1:30 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-1411
Practice Address - Country:US
Practice Address - Phone:914-462-7063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist