Healthcare Provider Details

I. General information

NPI: 1982945754
Provider Name (Legal Business Name): ELENA MARE BARONE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 QUINCY PL
WEST ISLIP NY
11795-1938
US

IV. Provider business mailing address

56 QUINCY PL
WEST ISLIP NY
11795-1938
US

V. Phone/Fax

Practice location:
  • Phone: 631-374-1905
  • Fax:
Mailing address:
  • Phone: 631-374-1905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number63 017274
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: