Provider Demographics
NPI:1821195157
Name:AHERN, ELIZABETH ROSE (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ROSE
Last Name:AHERN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 AHERN RD
Mailing Address - Street 2:
Mailing Address - City:SARANAC
Mailing Address - State:NY
Mailing Address - Zip Code:12981-2719
Mailing Address - Country:US
Mailing Address - Phone:518-293-7401
Mailing Address - Fax:
Practice Address - Street 1:3384 ROUTE 22
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:NY
Practice Address - Zip Code:12972
Practice Address - Country:US
Practice Address - Phone:518-643-8008
Practice Address - Fax:518-643-8090
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009293363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000416869005OtherBLUE SHIELD NENY
NY02149273Medicaid
NY000416869005OtherBLUE SHIELD NENY