Provider Demographics
NPI:1982420220
Name:ELIADES, KATHERINE (LMT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:ELIADES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 LAKELAND AVE APT 1-3A
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1943
Mailing Address - Country:US
Mailing Address - Phone:631-332-3293
Mailing Address - Fax:
Practice Address - Street 1:182 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6987
Practice Address - Country:US
Practice Address - Phone:631-673-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032741-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist