Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 026130 | NY |
NPI | 1063658854 |
---|---|
Provider Name | Ms. Elysa Graber |
First Address | Cedarhurst, NY 11516-1017 |
Second Address | Cedarhurst, NY 11516-1017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2008 |
Last Update Date | 28/12/2008 |