Provider Demographics
NPI:1518181791
Name:GANOPOLSKY, ELIZABETH
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:GANOPOLSKY
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 1:40 ENGLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2905
Mailing Address - Country:US
Mailing Address - Phone:201-567-0522
Mailing Address - Fax:201-567-5955
Practice Address - Street 1:40 ENGLE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2905
Practice Address - Country:US
Practice Address - Phone:201-567-0522
Practice Address - Fax:201-567-5955
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06944500207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8082502Medicaid
NJ8082502Medicaid
NJ033026Medicare ID - Type Unspecified