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NPI Code Detail

MEDICARE: ELIZABETH DETROYER CM

MEDICARE: ELIZABETH DETROYER CM
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
1176B00000XMidwife001740-1NY

General Provider Information

NPI Number : 1861845091
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH DETROYER CM
Provider Business Mailing Address
First Line : 500 E 77TH ST APT 1008
Second Line :
City : NEW YORK
State : NY
Zip : 10162-0026
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3424 KOSSUTH AVE
Second Line :
City : BRONX
State : NY
Zip : 10467-2489
Country : US
Telephone Number : 718-519-3872
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2016
Last Update Date : 02/08/2019

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