Provider Demographics
NPI:1043222060
Name:LESCOUFLAIR, ELISABETH MARIE-HELENE (MD)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:MARIE-HELENE
Last Name:LESCOUFLAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:585 SCHENECTADY AVE
Mailing Address - Street 2:MANAGED CARE DEPT. - 6TH FLOOR, BLUMBERG BLDG
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1809
Mailing Address - Country:US
Mailing Address - Phone:718-604-5469
Mailing Address - Fax:718-604-5527
Practice Address - Street 1:585 SCHENECTADY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1822
Practice Address - Country:US
Practice Address - Phone:718-604-5281
Practice Address - Fax:718-604-5527
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1958212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01635501Medicaid
NY54J261Medicare PIN
NYF91455Medicare UPIN