Provider Demographics
NPI:1750454427
Name:VANDERMEER-WYNKOOP, ELISABETH MARIA (MD-PHD)
Entity Type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:MARIA
Last Name:VANDERMEER-WYNKOOP
Suffix:
Gender:F
Credentials:MD-PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1568
Mailing Address - Country:US
Mailing Address - Phone:917-656-1439
Mailing Address - Fax:
Practice Address - Street 1:646 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1568
Practice Address - Country:US
Practice Address - Phone:917-656-1439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195016207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine