Provider Demographics
NPI:1669418992
Name:YOUNGEWIRTH, ELIZABETH (DPM)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:YOUNGEWIRTH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-3119
Mailing Address - Country:US
Mailing Address - Phone:212-567-6126
Mailing Address - Fax:212-567-7463
Practice Address - Street 1:4915 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-3119
Practice Address - Country:US
Practice Address - Phone:212-567-6126
Practice Address - Fax:212-567-7463
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005324-1213ES0131X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1250300001Medicare NSC
NYP73751Medicare ID - Type Unspecified
NYU63841Medicare UPIN