1801004858 NPI number — DR. ELENA L MARESCA-ROBERTSON AU.D.

Table of content: DR. ELENA L MARESCA-ROBERTSON AU.D. (NPI 1801004858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801004858 NPI number — DR. ELENA L MARESCA-ROBERTSON AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARESCA-ROBERTSON
Provider First Name:
ELENA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801004858
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 HALLOCK RD
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
STONY BROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11790-3033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-780-4327
Provider Business Mailing Address Fax Number:
631-675-6867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 HALLOCK RD
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11790-3033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-780-4327
Provider Business Practice Location Address Fax Number:
631-675-6867
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  001972-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AA37793 . This is a "HARVARD PILGRAM AUDIOLOGY" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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