Provider Demographics
NPI:1750544953
Name:WITZ, ELISE HAILEY (MASTERS OF ARTS)
Entity type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:HAILEY
Last Name:WITZ
Suffix:
Gender:F
Credentials:MASTERS OF ARTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 FORT SALONGA RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3088
Mailing Address - Country:US
Mailing Address - Phone:631-261-4327
Mailing Address - Fax:
Practice Address - Street 1:413 FORT SALONGA RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3088
Practice Address - Country:US
Practice Address - Phone:631-261-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY57002519231H00000X, 231H00000X
NY002519237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter