Provider Demographics
NPI:1538131370
Name:WILK-RIVARD, ELIZABETH J (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:J
Last Name:WILK-RIVARD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1212 5TH AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5210
Mailing Address - Country:US
Mailing Address - Phone:212-241-5555
Mailing Address - Fax:212-241-5658
Practice Address - Street 1:1212 5TH AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-5210
Practice Address - Country:US
Practice Address - Phone:212-241-5555
Practice Address - Fax:212-241-5658
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY210818-12083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH12574Medicare UPIN
NY58C561Medicare ID - Type Unspecified