Provider Demographics
NPI:1235289950
Name:BEAUTYMAN, ELIZABETH JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JANE
Last Name:BEAUTYMAN
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 1:315 W 57TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3158
Mailing Address - Country:US
Mailing Address - Phone:212-755-0285
Mailing Address - Fax:212-977-3494
Practice Address - Street 1:315 W 57TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3158
Practice Address - Country:US
Practice Address - Phone:212-755-0285
Practice Address - Fax:212-977-3494
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147796173000000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0450831OtherAETNA
485277OtherUNITED HEALTHCARE
NY8906224OtherCIGNA
133261571OtherGREAT WEST
133261571OtherHUMANA
133261571OtherGUARDIAN
B19130OtherATLANTIS
113AL1OtherBLUE CROSS BLUE SHIELD
NP171OtherOXFORD
NP171OtherOXFORD
NY133261571Medicare UPIN