1104941459 NPI number — MRS. ELIZABETH ANNE INGALLS PT

Table of content: CONNIE M GUTHRIE (NPI 1609421395)

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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