Provider Demographics
NPI:1457659427
Name:MASTRO, ELIZABETH JANE (NPP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANE
Last Name:MASTRO
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 RAILROAD PL APT 402
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2242
Mailing Address - Country:US
Mailing Address - Phone:518-441-2574
Mailing Address - Fax:518-244-8495
Practice Address - Street 1:75 RAILROAD PL
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2124
Practice Address - Country:US
Practice Address - Phone:518-441-2574
Practice Address - Fax:518-244-8495
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401365-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health