MEDICARE: DR. ELISABETH MARIA VANDERMEER-WYNKOOP MD-PH.D

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	207R00000X	Internal Medicine Physician	195016	NY

General Provider Information

NPI Number	:	1750454427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELISABETH MARIA VANDERMEER-WYNKOOP MD-PH.D

Provider Business Mailing Address
First Line	:	646 PROSPECT AVE
Second Line	:
City	:	LITTLE SILVER
State	:	NJ
Zip	:	07739-1568
Country	:	US
Telephone Number	:	917-656-1439
Fax Number	:

Provider Business Practice Location Address
First Line	:	646 PROSPECT AVE
Second Line	:
City	:	LITTLE SILVER
State	:	NJ
Zip	:	07739-1568
Country	:	US
Telephone Number	:	917-656-1439
Fax Number	:

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	11/10/2015

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