Healthcare Provider Details

I. General information

NPI: 1447349766
Provider Name (Legal Business Name): ELIZABETH A ODIERNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15811 HARRY VAN ARSDALE JR AVE
FLUSHING NY
11365-3085
US

IV. Provider business mailing address

15811 HARRY VAN ARSDALE JR AVE
FLUSHING NY
11365-3085
US

V. Phone/Fax

Practice location:
  • Phone: 718-591-2014
  • Fax: 718-591-9528
Mailing address:
  • Phone: 718-591-2014
  • Fax: 718-591-9528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number209510
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: