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NPI Code Detail

MEDICARE: ELISA HEBERT M.S.E.D

MEDICARE: ELISA HEBERT M.S.E.D
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
1174400000XSpecialist1278322NY

General Provider Information

NPI Number : 1033585971
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISA HEBERT M.S.E.D
Provider Business Mailing Address
First Line : 3602 14TH ST
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11106-4704
Country : US
Telephone Number : 718-392-2510
Fax Number :
Provider Business Practice Location Address
First Line : 3602 14TH ST
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11106-4704
Country : US
Telephone Number : 718-392-2510
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2015
Last Update Date : 08/14/2015

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