Provider Demographics
NPI:1205802055
Name:LOUIE, BETH G (MD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:G
Last Name:LOUIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:33 RONALD REAGAN BLVD
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-4114
Mailing Address - Country:US
Mailing Address - Phone:845-986-5352
Mailing Address - Fax:845-986-6341
Practice Address - Street 1:PO BOX 309
Practice Address - Street 2:33 RONALD REAGAN BLVD
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-4114
Practice Address - Country:US
Practice Address - Phone:845-986-5352
Practice Address - Fax:845-986-6341
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131379207K00000X
NJ25MA03767100207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
030005438OtherRAILROAD MEDICARE
P2717817OtherOXFORD
NY00345919Medicaid
2099821OtherGHI
9109891007OtherCIGNA
169639POtherHIP PRIS
3124889OtherAETNA HMO
4C5129OtherHEALTHNET
71233OtherGHI HMO
5N6671OtherWELLCHOICE
213824OtherWELLCARE
5362617OtherAETNA PPO
5362617OtherAETNA PPO
4C5129OtherHEALTHNET
169639POtherHIP PRIS