Provider Demographics
NPI:1871792440
Name:MOLDOWSKY, LISA ELSNER (RN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ELSNER
Last Name:MOLDOWSKY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CAROL LN
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5750
Mailing Address - Country:US
Mailing Address - Phone:516-334-5059
Mailing Address - Fax:
Practice Address - Street 1:7 CAROL LN
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5750
Practice Address - Country:US
Practice Address - Phone:516-334-5059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY434368-1163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02357380Medicaid