Provider Demographics
NPI:1134578578
Name:KIETZ, ELIZABETH LAUREN (PA-C)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:LAUREN
Last Name:KIETZ
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:530 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-263-2192
Mailing Address - Fax:
Practice Address - Street 1:530 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-2192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2021-11-15
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant