Basic Information
Provider Information
NPI: 1033504154
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHARP
FirstName: ELIZABETH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 129 W 29TH ST FL 10
Address2:  
City: NEW YORK
State: NY
PostalCode: 100015105
CountryCode: US
TelephoneNumber: 4156586791
FaxNumber: 4155200904
Practice Location
Address1: 76 9TH AVE STE 810
Address2:  
City: NEW YORK
State: NY
PostalCode: 100114962
CountryCode: US
TelephoneNumber: 2126241080
FaxNumber: 2128674353
Other Information
ProviderEnumerationDate: 04/06/2015
LastUpdateDate: 04/14/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/14/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X294873NYY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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