Provider Demographics
NPI:1871002089
Name:PAGE, ELIZABETH DONNA (SPECIAL EDUCATION)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DONNA
Last Name:PAGE
Suffix:
Gender:F
Credentials:SPECIAL EDUCATION
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:DONNA
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21 HIGH MILLS RD
Mailing Address - Street 2:
Mailing Address - City:BURNT HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:12027-9436
Mailing Address - Country:US
Mailing Address - Phone:518-396-0328
Mailing Address - Fax:
Practice Address - Street 1:43 HENRIETTA BLVD
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1110
Practice Address - Country:US
Practice Address - Phone:518-843-3003
Practice Address - Fax:518-842-2305
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17660061174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist