Healthcare Provider Details

I. General information

NPI: 1659913457
Provider Name (Legal Business Name): ELIZABETH GEVARGIZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2019
Last Update Date: 10/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 10TH AVE
BROOKLYN NY
11219-2916
US

IV. Provider business mailing address

2271 E 59TH PL
BROOKLYN NY
11234-6401
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-6395
  • Fax:
Mailing address:
  • Phone: 718-209-1915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF343393-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: