Healthcare Provider Details

I. General information

NPI: 1063646958
Provider Name (Legal Business Name): ELIZABETH EFIMETZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 HARRIS ST
PATCHOGUE NY
11772-1706
US

IV. Provider business mailing address

64 HARRIS ST
PATCHOGUE NY
11772-1706
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-3472
  • Fax:
Mailing address:
  • Phone: 631-475-3472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: