MEDICARE: ELIZABETH ANNE FORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A99193	CA
2	208000000X	Pediatrics Physician	240780	NY

General Provider Information

NPI Number	:	1740486786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANNE FORD

Provider Business Mailing Address
First Line	:	4234 BRONX BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2668
Country	:	US
Telephone Number	:	347-341-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	4234 BRONX BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2668
Country	:	US
Telephone Number	:	347-341-4300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	03/07/2023

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Directions to “ ELIZABETH ANNE FORD ” Practice Location

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