Provider Demographics
NPI:1932374527
Name:TRETOLA, ELI (DC)
Entity Type:Individual
Prefix:
First Name:ELI
Middle Name:
Last Name:TRETOLA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-0208
Mailing Address - Country:US
Mailing Address - Phone:516-785-1311
Mailing Address - Fax:
Practice Address - Street 1:233 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3562
Practice Address - Country:US
Practice Address - Phone:516-785-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009973-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor