Provider Demographics
NPI:1114458148
Name:MECONI, ELIZABETH (TSHH)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MECONI
Suffix:
Gender:F
Credentials:TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:AU SABLE FORKS
Mailing Address - State:NY
Mailing Address - Zip Code:12912-0492
Mailing Address - Country:US
Mailing Address - Phone:518-569-5254
Mailing Address - Fax:
Practice Address - Street 1:1701 FRONT ST
Practice Address - Street 2:
Practice Address - City:KEESEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12944-3619
Practice Address - Country:US
Practice Address - Phone:518-569-5254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist