Healthcare Provider Details

I. General information

NPI: 1376768226
Provider Name (Legal Business Name): ELIZABETH M OUDENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VARICK ST 9TH FLOOR
NEW YORK NY
10014-4810
US

IV. Provider business mailing address

200 VARICK ST 9TH FLOOR
NEW YORK NY
10014-4810
US

V. Phone/Fax

Practice location:
  • Phone: 212-620-0340
  • Fax:
Mailing address:
  • Phone: 212-620-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number214545
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: