Provider Demographics
NPI:1386813574
Name:DELIGIANNIS, ELISA E (BS)
Entity type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:E
Last Name:DELIGIANNIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4240
Mailing Address - Country:US
Mailing Address - Phone:516-223-8392
Mailing Address - Fax:516-223-8342
Practice Address - Street 1:951 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4240
Practice Address - Country:US
Practice Address - Phone:516-223-8392
Practice Address - Fax:516-223-8342
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01552125Medicaid