Provider Demographics
NPI:1013522515
Name:CONTRERAS, ELSIE PATRICIA
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:PATRICIA
Last Name:CONTRERAS
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 1:6302 POLK ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1628
Mailing Address - Country:US
Mailing Address - Phone:201-328-2540
Mailing Address - Fax:
Practice Address - Street 1:6302 POLK ST APT 3
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1628
Practice Address - Country:US
Practice Address - Phone:201-328-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01251600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist