Provider Demographics
NPI:1124017702
Name:DELA TORRE, ELIZABETH LAURON (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAURON
Last Name:DELA TORRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:CAREMOUNT MEDICAL PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-242-1516
Practice Address - Street 1:10 CRANBERRY DR
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-5367
Practice Address - Country:US
Practice Address - Phone:845-231-5600
Practice Address - Fax:845-231-5699
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02760492Medicaid
NYA400116285Medicare PIN
NY02760492Medicaid
NY257SM1Medicare PIN