Provider Demographics
NPI:1093045353
Name:DUBOIS, ELIZABETH MARIE (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MADISON AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1600
Mailing Address - Country:US
Mailing Address - Phone:212-545-2439
Mailing Address - Fax:646-312-0481
Practice Address - Street 1:975 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3204
Practice Address - Country:US
Practice Address - Phone:718-320-4466
Practice Address - Fax:718-991-3829
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-10
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NYG100000410Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
NY331043Medicare Oscar/Certification
NY331954Medicare Oscar/Certification
NY331957Medicare Oscar/Certification
NY571000Medicare Oscar/Certification
NY331943Medicare Oscar/Certification
NY331945Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY331058Medicare Oscar/Certification
NY331952Medicare Oscar/Certification
NY331496Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
NY331944Medicare Oscar/Certification
NY331978Medicare Oscar/Certification