Provider Demographics
NPI:1679834790
Name:GODSHALL, ELIZABETH SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUSAN
Last Name:GODSHALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3795 CROMPOND RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-7214
Mailing Address - Country:US
Mailing Address - Phone:800-633-8446
Mailing Address - Fax:888-502-6582
Practice Address - Street 1:3795 CROMPOND RD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-7214
Practice Address - Country:US
Practice Address - Phone:800-633-8446
Practice Address - Fax:888-502-6582
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA10468000208600000X
PAMD459926208600000X
NY295407208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery