Healthcare Provider Details

I. General information

NPI: 1952911042
Provider Name (Legal Business Name): ELIZABETH FARRA XU NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

125 COURT ST APT 5SI
BROOKLYN NY
11201-0143
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-5454
  • Fax:
Mailing address:
  • Phone: 317-442-9262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number708528
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number350517
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: