1598059040 NPI number — MISS ELIZABETH GRACE WOOD M.S.

Table of content: MISS ELIZABETH GRACE WOOD M.S. (NPI 1598059040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598059040 NPI number — MISS ELIZABETH GRACE WOOD M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
ELIZABETH
Provider Middle Name:
GRACE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598059040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
132 LIVERMORE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DRYDEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13053-9507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-423-8083
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1045 JAMES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13203-2730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-425-1004
Provider Business Practice Location Address Fax Number:
315-479-7884
Provider Enumeration Date:
06/01/2011

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: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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