MEDICARE: DR. ELIZABETH BRIGHTSTAR ENSCHEDE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	255134	NY

General Provider Information

NPI Number	:	1316108533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH BRIGHTSTAR ENSCHEDE MD

Provider Business Mailing Address
First Line	:	PO BOX 95000-2454
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19195-2454
Country	:	US
Telephone Number	:	212-352-2600
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 W 23RD ST
Second Line	:	1ST FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10011-2301
Country	:	US
Telephone Number	:	212-352-2600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	09/06/2012

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