Provider Demographics
NPI:1063540672
Name:CATALANOHANSON, ELISA LOUISE (OTR)
Entity type:Individual
Prefix:MS
First Name:ELISA
Middle Name:LOUISE
Last Name:CATALANOHANSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 OCEANVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2956
Mailing Address - Country:US
Mailing Address - Phone:631-325-8339
Mailing Address - Fax:631-325-8339
Practice Address - Street 1:30 OCEANVIEW BLVD
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-2956
Practice Address - Country:US
Practice Address - Phone:631-325-8339
Practice Address - Fax:631-325-8339
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006304-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor