1174692040 NPI number — DR. ELIZABETH ANNE KITSIS M.D.

Table of content: DR. ELIZABETH ANNE KITSIS M.D. (NPI 1174692040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174692040 NPI number — DR. ELIZABETH ANNE KITSIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KITSIS
Provider First Name:
ELIZABETH
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COHEN
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174692040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 MORRIS PARK AVE
Provider Second Line Business Mailing Address:
ALBERT EINSTEIN COLLEGE OF MEDICINE, MAZER BUILDING
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10461-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-430-4242
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1825 EASTCHESTER RD
Provider Second Line Business Practice Location Address:
DIVISION OF RHEUMATOLOGY
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10461-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-430-4242
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2006

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: 207RR0500X , with the licence number:  171996 , 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)





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