MEDICARE: ELISE PIE B.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	429	CT

General Provider Information

NPI Number	:	1215380068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE PIE B.S.

Provider Business Mailing Address
First Line	:	166 SUN VALLEY DR
Second Line	:
City	:	SOUTHINGTON
State	:	CT
Zip	:	06489-2733
Country	:	US
Telephone Number	:	860-817-5506
Fax Number	:

Provider Business Practice Location Address
First Line	:	166 SUN VALLEY DR
Second Line	:
City	:	SOUTHINGTON
State	:	CT
Zip	:	06489-2733
Country	:	US
Telephone Number	:	860-817-5506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2016
Last Update Date	:	07/18/2016

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