1104941459 NPI number — MRS. ELIZABETH ANNE INGALLS PT

Table of content: MRS. ELIZABETH ANNE INGALLS PT (NPI 1104941459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104941459 NPI number — MRS. ELIZABETH ANNE INGALLS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INGALLS
Provider First Name:
ELIZABETH
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MALTA
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
BS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104941459
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 PENFIELD AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROTON ON HUDSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-271-2713
Provider Business Mailing Address Fax Number:
914-271-2713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 EAST 61ST ST 3RD FL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-261-1060
Provider Business Practice Location Address Fax Number:
914-271-2713
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  015539 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P2532272 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: QP0371 . This is a "WESTCHESTER BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2263473 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02380050 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12001569 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: QP0372 . This is a "MANHATTAN BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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