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General NPI Number Information
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NPI Number | 1679834790
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Entity Type | Individual
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Provider Name | ELIZABETH SUSAN GODSHALL M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/05/2012
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Last Update Date | 01/25/2019
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Provider Practice Location Address
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Address Line | 3795 CROMPOND RD
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City | CORTLANDT MANOR
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State | NY
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Zip | 10567-7214
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Country | US
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Telephone | 800-633-8446
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Fax | 888-502-6582
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Provider Business Mailing Address
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Address Line | 3795 CROMPOND RD
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City | CORTLANDT MANOR
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State | NY
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Zip | 10567-7214
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Country | US
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Telephone | 800-633-8446
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Fax | 888-502-6582
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA10468000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD459926
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 295407
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License Number State | NY
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