Provider Demographics
NPI:1013561513
Name:WRIGHT, ELYSE JOY (MS)
Entity Type:Individual
Prefix:MRS
First Name:ELYSE
Middle Name:JOY
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 IVORY COURT
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731
Mailing Address - Country:US
Mailing Address - Phone:631-486-2015
Mailing Address - Fax:
Practice Address - Street 1:1014 GRAND BOULEVARD SUITE 5
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729
Practice Address - Country:US
Practice Address - Phone:631-243-1765
Practice Address - Fax:631-243-3716
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282370031174400000X, 246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty