Healthcare Provider Details

I. General information

NPI: 1841877768
Provider Name (Legal Business Name): ELIZABETH PETERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE 2700S
HAWTHORNE NY
10532-2170
US

IV. Provider business mailing address

19 BRADHURST AVE STE 3100N
HAWTHORNE NY
10532-2140
US

V. Phone/Fax

Practice location:
  • Phone: 847-606-0173
  • Fax:
Mailing address:
  • Phone: 914-231-8373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number337312-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: