Provider Demographics
NPI:1255310090
Name:ROSS, ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 ROUTE 304
Mailing Address - Street 2:SE CORNER
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3040
Mailing Address - Country:US
Mailing Address - Phone:845-639-6800
Mailing Address - Fax:845-639-6814
Practice Address - Street 1:490 ROUTE 304
Practice Address - Street 2:SE CORNER
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3040
Practice Address - Country:US
Practice Address - Phone:845-639-6800
Practice Address - Fax:845-639-6814
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ84261Medicare ID - Type UnspecifiedMEDICARE
NYSO4138Medicare UPIN