Healthcare Provider Details

I. General information

NPI: 1740486786
Provider Name (Legal Business Name): ELIZABETH ANNE FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 BRONX BLVD
BRONX NY
10466-2668
US

IV. Provider business mailing address

4234 BRONX BLVD
BRONX NY
10466-2668
US

V. Phone/Fax

Practice location:
  • Phone: 347-341-4300
  • Fax:
Mailing address:
  • Phone: 347-341-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA99193
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number240780
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: