Provider Demographics
NPI:1760549836
Name:HAENI, ELIZABETH A (DPM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:HAENI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 MEADOW GLEN RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2711
Mailing Address - Country:US
Mailing Address - Phone:631-262-3331
Mailing Address - Fax:631-262-0849
Practice Address - Street 1:50 MEADOW GLEN RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2711
Practice Address - Country:US
Practice Address - Phone:631-262-0849
Practice Address - Fax:631-262-0849
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004746213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4268820001Medicare NSC
NYU29691Medicare UPIN