Provider Demographics
NPI:1134482680
Name:TOLLNER, ELISE
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:TOLLNER
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 1:12 CHARLES ST
Mailing Address - Street 2:APT. 5C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3018
Mailing Address - Country:US
Mailing Address - Phone:212-929-6226
Mailing Address - Fax:
Practice Address - Street 1:12 CHARLES ST
Practice Address - Street 2:APT. 5C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3018
Practice Address - Country:US
Practice Address - Phone:212-929-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist