Provider Demographics
NPI:1336587104
Name:GARRY ELLIOTT, JOANNE
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:
Last Name:GARRY ELLIOTT
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 1:421 W 162ND ST APT 3I
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-8144
Mailing Address - Country:US
Mailing Address - Phone:212-740-9812
Mailing Address - Fax:
Practice Address - Street 1:2367-69 SECOND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035
Practice Address - Country:US
Practice Address - Phone:212-876-2300
Practice Address - Fax:212-722-7618
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300390-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse