1962607309 NPI number — DR. ELIZABETH BAILEY RODGERS MD

Table of content: DR. ELIZABETH BAILEY RODGERS MD (NPI 1962607309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962607309 NPI number — DR. ELIZABETH BAILEY RODGERS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODGERS
Provider First Name:
ELIZABETH
Provider Middle Name:
BAILEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAILEY
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
DIVER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962607309
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
135 SPRING ST
Provider Second Line Business Mailing Address:
201 W
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10012-3858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-219-1187
Provider Business Mailing Address Fax Number:
212-219-1538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 SPRING ST
Provider Second Line Business Practice Location Address:
201 W
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10012-3858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-219-1187
Provider Business Practice Location Address Fax Number:
212-219-1538
Provider Enumeration Date:
06/16/2007

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: 207V00000X , with the licence number:  2590201 , 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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