Provider Demographics
NPI:1760628820
Name:REVERE, ELIZABETH KNACKMUHS (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:KNACKMUHS
Last Name:REVERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARY
Other - Last Name:KNACKMUHS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:400 COMMUNITY DRIVE
Mailing Address - Street 2:DIVISION OF INFECTIOUS DISEASES
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:516-562-4280
Mailing Address - Fax:516-562-2626
Practice Address - Street 1:400 COMMUNITY DRIVE
Practice Address - Street 2:DIVISION OF INFECTIOUS DISEASES
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-562-4280
Practice Address - Fax:516-562-2626
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250049207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine