Provider Demographics
NPI:1902629462
Name:CRUSE, ELYSA
Entity type:Individual
Prefix:
First Name:ELYSA
Middle Name:
Last Name:CRUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COTTONTAIL RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-3202
Mailing Address - Country:US
Mailing Address - Phone:203-561-5694
Mailing Address - Fax:
Practice Address - Street 1:38B GROVE ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4665
Practice Address - Country:US
Practice Address - Phone:203-561-5694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered