Provider Demographics
NPI:1700099231
Name:VISCEGLIA, ELIZABETH ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ROSE
Last Name:VISCEGLIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:77 WEST 104 ST, APT 4B
Mailing Address - Street 2:
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:917-536-5437
Mailing Address - Fax:212-864-5344
Practice Address - Street 1:MONTEFIORE MEDICAL CENTER, DEPT OF PSYCHIATRY
Practice Address - Street 2:111 EAST 210TH ST
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-7967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY602384622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry