Provider Demographics
NPI:1477880235
Name:BLOCK, ELIZABETH ELLEN
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ELLEN
Last Name:BLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4709
Mailing Address - Country:US
Mailing Address - Phone:212-473-4700
Mailing Address - Fax:
Practice Address - Street 1:817 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4709
Practice Address - Country:US
Practice Address - Phone:212-473-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-14
Last Update Date:2009-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY39469122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist