Provider Demographics
NPI:1245234681
Name:FARRIGAN, ELIZABETH SUSAN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SUSAN
Last Name:FARRIGAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:SUSAN
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:848 ROUTE 50
Mailing Address - Street 2:
Mailing Address - City:BURNT HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:12027-9511
Mailing Address - Country:US
Mailing Address - Phone:518-831-1500
Mailing Address - Fax:518-377-1677
Practice Address - Street 1:848 ROUTE 50
Practice Address - Street 2:
Practice Address - City:BURNT HILLS
Practice Address - State:NY
Practice Address - Zip Code:12027
Practice Address - Country:US
Practice Address - Phone:518-831-1500
Practice Address - Fax:518-280-8464
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF33255363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC7517Medicare ID - Type Unspecified
P37454Medicare UPIN