Individual
ELISA KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PROVISIONAL PSS
Contact information
Practice address
1560 TOWNSEND AVE APT 2I, BRONX, NY 10452-6021
(347) 556-7598
Mailing address
1560 TOWNSEND AVE APT 2I, BRONX, NY 10452-6021
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
NYCPS-P-2077
NY
Other
Enumeration date
02/16/2022
Last updated
02/16/2022
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