Provider Demographics
NPI:1396850061
Name:MIRRO, ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MIRRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 NEWBRIDGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2150
Mailing Address - Country:US
Mailing Address - Phone:516-745-0303
Mailing Address - Fax:516-745-0588
Practice Address - Street 1:30 NEWBRIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2150
Practice Address - Country:US
Practice Address - Phone:516-745-0303
Practice Address - Fax:516-745-0588
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY211424-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH30959Medicare UPIN