Provider Demographics
NPI:1669722369
Name:MCCARTHY, ELIZABETH G (DPT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:G
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HURON PL
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3312
Mailing Address - Country:US
Mailing Address - Phone:347-219-9323
Mailing Address - Fax:
Practice Address - Street 1:19 HURON PL
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3312
Practice Address - Country:US
Practice Address - Phone:347-219-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01464200225100000X
NY035641-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist