Provider Demographics
NPI:1699107599
Name:FUNGKHEE, ELIZABETH C (CASAC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:C
Last Name:FUNGKHEE
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-1318
Mailing Address - Country:US
Mailing Address - Phone:516-486-7200
Mailing Address - Fax:516-486-7291
Practice Address - Street 1:126 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-1318
Practice Address - Country:US
Practice Address - Phone:516-486-7200
Practice Address - Fax:516-486-7291
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11689101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11689OtherCASAC