Provider Demographics
NPI:1447495528
Name:CLOSE, ELAINE VETRANO (MS)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:VETRANO
Last Name:CLOSE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1551
Mailing Address - Country:US
Mailing Address - Phone:631-988-7690
Mailing Address - Fax:
Practice Address - Street 1:41 NORTH DR
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1551
Practice Address - Country:US
Practice Address - Phone:631-988-7690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000716231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist