Provider Demographics
NPI:1184985293
Name:ELDER, COLETTE PAULINE
Entity type:Individual
Prefix:
First Name:COLETTE
Middle Name:PAULINE
Last Name:ELDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COLETTE
Other - Middle Name:PAULINE
Other - Last Name:ELDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSED
Mailing Address - Street 1:8 OSAGE LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6124
Mailing Address - Country:US
Mailing Address - Phone:917-939-0602
Mailing Address - Fax:
Practice Address - Street 1:8 OSAGE LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6124
Practice Address - Country:US
Practice Address - Phone:917-939-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist