Provider Demographics
NPI:1356578017
Name:ELISH-SWARTZ, ALYSON
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:ELISH-SWARTZ
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 1:47 BOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2907
Mailing Address - Country:US
Mailing Address - Phone:631-780-5405
Mailing Address - Fax:
Practice Address - Street 1:47 BOXWOOD DR
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-2907
Practice Address - Country:US
Practice Address - Phone:631-780-5405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009349235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist