Provider Demographics
NPI:1023548195
Name:DECKER, ELISSA (SPEECH-LANGUAGE PATH)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:DECKER
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:ELISSA
Other - Middle Name:
Other - Last Name:ROTWEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPEECH-LANGUAGE PATH
Mailing Address - Street 1:840 SHORE ROAD
Mailing Address - Street 2:APT 1J
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:116 W 32ND ST FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3212
Practice Address - Country:US
Practice Address - Phone:212-564-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05144918Medicaid