Provider Demographics
NPI:1851816029
Name:MENSCH, ELIZABETH FAYE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:FAYE
Last Name:MENSCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 FORMAT LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5540
Mailing Address - Country:US
Mailing Address - Phone:631-826-5036
Mailing Address - Fax:
Practice Address - Street 1:220 N BELLE MEAD RD STE A
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3523
Practice Address - Country:US
Practice Address - Phone:631-941-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF308298-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health