Provider Demographics
NPI:1275860611
Name:DE LA RIVA-VELASCO, ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
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Last Name:DE LA RIVA-VELASCO
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Gender:F
Credentials:MD
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Mailing Address - Street 1:22 SAW MILL RIVER RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1533
Mailing Address - Country:US
Mailing Address - Phone:914-493-7585
Mailing Address - Fax:914-594-4336
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:SUITE 1400
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-493-7585
Practice Address - Fax:914-594-4336
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2013-07-23
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Provider Licenses
StateLicense IDTaxonomies
NY2439452080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03249832Medicaid
NYA400032584Medicare PIN
NY03249832Medicaid