Provider Demographics
NPI:1831311570
Name:HAAGEN, ELAINE KATHRYN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:KATHRYN
Last Name:HAAGEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 NEWBERRY PL
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-3337
Mailing Address - Country:US
Mailing Address - Phone:914-967-1600
Mailing Address - Fax:914-967-4993
Practice Address - Street 1:20 NEWBERRY PL
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-3337
Practice Address - Country:US
Practice Address - Phone:914-967-1600
Practice Address - Fax:914-967-4993
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1096132084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB18827Medicare UPIN