1841604824 NPI number — MRS. ELISA SAMUELS MA, CCC-SLP

Table of content: DARLA JEAN CLIFT PA (NPI 1730306879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841604824 NPI number — MRS. ELISA SAMUELS MA, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAMUELS
Provider First Name:
ELISA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAMUELS
Provider Other First Name:
ELISHEVA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, CCC-SLP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1841604824
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/30/2015
NPI Reactivation Date:
11/30/2016

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
983 WOOD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODMERE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11598-1726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-398-5635
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15010 71ST AVE
Provider Second Line Business Practice Location Address:
APT. 4B
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11367-2143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-398-5635
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2014

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: 235Z00000X , with the licence number:  021281 , 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)





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