Provider Demographics
NPI:1477535300
Name:AVARICIO, ELIZABETH D (MD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:D
Last Name:AVARICIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9511 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2500
Mailing Address - Country:US
Mailing Address - Phone:718-848-1171
Mailing Address - Fax:718-323-0032
Practice Address - Street 1:9511 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2500
Practice Address - Country:US
Practice Address - Phone:718-848-1171
Practice Address - Fax:718-323-0032
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222937208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02367471Medicaid