Individual
DR. ELSA GISELLA ESMERALDA MIRASOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
79 MIDDLEVILLE RD, NORTHPORT, NY 11768-2200
(631) 261-4400
Mailing address
79 MIDDLEVILLE RD, NORTHPORT, NY 11768-2200
(631) 261-4400
Taxonomy
Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
Primary
236889-1
NY
2084P0800X
Psychiatry Physician
236889-1
NY
Other
Enumeration date
05/31/2006
Last updated
12/17/2010
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