Provider Demographics
NPI:1588869952
Name:KORN, ELIZABETH AMY (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:AMY
Last Name:KORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 EASTON AVE
Mailing Address - Street 2:MOB 3RD FLOOR
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1766
Mailing Address - Country:US
Mailing Address - Phone:732-745-8574
Mailing Address - Fax:732-514-1956
Practice Address - Street 1:254 EASTON AVE
Practice Address - Street 2:MOB 3RD FLOOR
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1766
Practice Address - Country:US
Practice Address - Phone:732-745-8574
Practice Address - Fax:732-514-1956
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA068492002080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ117535Medicare PIN