Provider Demographics
NPI:1932460904
Name:LOSCIALO, ELIZABETH A
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:LOSCIALO
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 1:1535 RICHMOND AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1520
Mailing Address - Country:US
Mailing Address - Phone:718-556-1616
Mailing Address - Fax:718-442-9962
Practice Address - Street 1:1535 RICHMOND AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1520
Practice Address - Country:US
Practice Address - Phone:718-556-1616
Practice Address - Fax:718-442-9962
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NY505026111171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor