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NPI Code Detail

MEDICARE: DR. ELYSE BILLOW PH.D.

MEDICARE: DR. ELYSE BILLOW PH.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
1103T00000XPsychologist9989NY

General Provider Information

NPI Number : 1053541425
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELYSE BILLOW PH.D.
Provider Business Mailing Address
First Line : 49 CEDAR DR
Second Line :
City : GREAT NECK
State : NY
Zip : 11021-1935
Country : US
Telephone Number : 516-829-6089
Fax Number : 516-829-9691
Provider Business Practice Location Address
First Line : 49 CEDAR DR
Second Line :
City : GREAT NECK
State : NY
Zip : 11021-1935
Country : US
Telephone Number : 516-829-6089
Fax Number : 516-829-9691
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2009
Last Update Date : 07/20/2009

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