Provider Demographics
NPI:1912497900
Name:LE MONIER, ELISHA N
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:N
Last Name:LE MONIER
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 1:21 MARTIN LUTHER KING DR APT A
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-6710
Mailing Address - Country:US
Mailing Address - Phone:347-325-4590
Mailing Address - Fax:
Practice Address - Street 1:17 BANK AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2703
Practice Address - Country:US
Practice Address - Phone:631-265-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2019-06-06
Deactivation Date:2018-12-28
Deactivation Code:
Reactivation Date:2019-06-06
Provider Licenses
StateLicense IDTaxonomies
NY330963164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse