Healthcare Provider Details

I. General information

NPI: 1770847204
Provider Name (Legal Business Name): BARBARA ELISA PELUSO M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 79TH ST
BROOKLYN NY
11228-2710
US

IV. Provider business mailing address

1314 79TH ST
BROOKLYN NY
11228-2710
US

V. Phone/Fax

Practice location:
  • Phone: 917-748-8025
  • Fax:
Mailing address:
  • Phone: 917-748-8025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number174400000X
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: