Provider Demographics
NPI:1154744472
Name:TAUB, ELIZABETH
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:TAUB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 AVENUE C
Mailing Address - Street 2:12A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2301
Mailing Address - Country:US
Mailing Address - Phone:917-539-2037
Mailing Address - Fax:
Practice Address - Street 1:285 AVENUE C
Practice Address - Street 2:12A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-2301
Practice Address - Country:US
Practice Address - Phone:917-539-2037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29187101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12442402OtherOXFORD MEDICARE