Healthcare Provider Details

I. General information

NPI: 1174178222
Provider Name (Legal Business Name): ELIZABETH JAHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HATFIELD LN STE 105
GOSHEN NY
10924-6768
US

IV. Provider business mailing address

2 COATES DR
GOSHEN NY
10924-6758
US

V. Phone/Fax

Practice location:
  • Phone: 845-291-7400
  • Fax: 845-291-7049
Mailing address:
  • Phone: 845-651-1400
  • Fax: 845-651-1512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF344238-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: