Provider Demographics
NPI:1104941459
Name:INGALLS, ELIZABETH ANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:INGALLS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:MALTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:1 PENFIELD AVENUE
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520
Mailing Address - Country:US
Mailing Address - Phone:914-271-2713
Mailing Address - Fax:914-271-2713
Practice Address - Street 1:170 EAST 61ST ST 3RD FL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:914-261-1060
Practice Address - Fax:914-271-2713
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0155392251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2532272OtherOXFORD
NYQP0371OtherWESTCHESTER BCBS
NY2263473OtherUNITED HEALTH CARE
NY02380050Medicaid
NY12001569OtherMULTIPLAN
NYQP0372OtherMANHATTAN BCBS
QT0421Medicare ID - Type Unspecified