Healthcare Provider Details

I. General information

NPI: 1396487500
Provider Name (Legal Business Name): ELISABETH GEORGE WASHBURN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E 38TH ST
NEW YORK NY
10016-2708
US

IV. Provider business mailing address

167 E 61ST ST APT 6E
NEW YORK NY
10065-8148
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5889
  • Fax:
Mailing address:
  • Phone: 631-478-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number346354
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: