1235289950 NPI number — DR. ELIZABETH JANE BEAUTYMAN M.D.

Table of content: DR. ELIZABETH JANE BEAUTYMAN M.D. (NPI 1235289950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235289950 NPI number — DR. ELIZABETH JANE BEAUTYMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEAUTYMAN
Provider First Name:
ELIZABETH
Provider Middle Name:
JANE
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:
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:
1235289950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 W 57TH ST
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10019-3158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-755-0285
Provider Business Mailing Address Fax Number:
212-977-3494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 W 57TH ST
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10019-3158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-755-0285
Provider Business Practice Location Address Fax Number:
212-977-3494
Provider Enumeration Date:
01/12/2007

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: 173000000X , with the licence number:  147796 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 147796 , 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: 0450831 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 485277 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8906224 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 133261571 . This is a "GREAT WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 133261571 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 133261571 . This is a "GUARDIAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: B19130 . This is a "ATLANTIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113AL1 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: NP171 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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