Provider Demographics
NPI:1811091259
Name:ELIN, YISROEL (PT)
Entity type:Individual
Prefix:MR
First Name:YISROEL
Middle Name:
Last Name:ELIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 TOWER RD
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-1634
Mailing Address - Country:US
Mailing Address - Phone:203-755-5116
Mailing Address - Fax:
Practice Address - Street 1:60 TOWER RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710-1634
Practice Address - Country:US
Practice Address - Phone:203-755-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007282225100000X
NY024873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist