Healthcare Provider Details

I. General information

NPI: 1275805244
Provider Name (Legal Business Name): NATALIA ELSON,DDS,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 ISLIP AVE STE 5
ISLIP NY
11751-3222
US

IV. Provider business mailing address

150 ISLIP AVE STE 5
ISLIP NY
11751-3222
US

V. Phone/Fax

Practice location:
  • Phone: 631-525-3827
  • Fax: 631-514-2468
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number055703
License Number StateNY

VIII. Authorized Official

Name: DR. NATALIA ELSON
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 631-525-3827