Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | X012856 | NY |
NPI | 1639625775 |
---|---|
Provider Name | Dr. Elyse Victoria Tursi |
First Address | Commack, NY 11725-3405 |
Second Address | Commack, NY 11725-3405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2016 |
Last Update Date | 29/08/2016 |