Provider Demographics
NPI:1982882825
Name:ELSEROAD, DAVID ALLAN (MDIV)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLAN
Last Name:ELSEROAD
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LINCOLN AVE
Mailing Address - Street 2:APT. #3W
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1122
Mailing Address - Country:US
Mailing Address - Phone:917-757-4749
Mailing Address - Fax:
Practice Address - Street 1:40 LINCOLN AVE
Practice Address - Street 2:APT. #3W
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-1122
Practice Address - Country:US
Practice Address - Phone:917-757-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-02
Last Update Date:2008-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000674106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist