Healthcare Provider Details

I. General information

NPI: 1811239635
Provider Name (Legal Business Name): ELISE SNYDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 FDR DR APT B1704
NEW YORK NY
10002-5916
US

IV. Provider business mailing address

455 FDR DR APT B1704
NEW YORK NY
10002-5916
US

V. Phone/Fax

Practice location:
  • Phone: 212-533-0310
  • Fax: 212-202-3928
Mailing address:
  • Phone: 212-533-0310
  • Fax: 212-202-3928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number083354-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: