Provider Demographics
NPI:1558462473
Name:SUBLETTE, M ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:M ELIZABETH
Middle Name:
Last Name:SUBLETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2425
Mailing Address - Country:US
Mailing Address - Phone:718-859-1276
Mailing Address - Fax:718-859-1246
Practice Address - Street 1:1601 AVENUE H
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2425
Practice Address - Country:US
Practice Address - Phone:718-859-1276
Practice Address - Fax:718-859-1246
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2194782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry