Provider Demographics
NPI:1215259411
Name:CORTEZ, ELIZABETH TOWNE (PA)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:TOWNE
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:TOWNE
Other - Last Name:DUBOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:16 PUTNAM PL
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746
Mailing Address - Country:US
Mailing Address - Phone:631-796-7938
Mailing Address - Fax:718-991-4516
Practice Address - Street 1:596 JERICHO TURNPIKE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791
Practice Address - Country:US
Practice Address - Phone:516-677-5437
Practice Address - Fax:718-991-4516
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013847363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant