Provider Demographics
NPI:1821762972
Name:ARISTIZABAL, EMILY (OD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:ARISTIZABAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-3008
Mailing Address - Country:US
Mailing Address - Phone:845-664-4842
Mailing Address - Fax:
Practice Address - Street 1:100 NEW MAIN ST
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3808
Practice Address - Country:US
Practice Address - Phone:914-965-5367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009427152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist