Provider Demographics
NPI:1518933316
Name:ELSABROUT, KERRI ELIZABETH BUCH (NP)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:ELIZABETH BUCH
Last Name:ELSABROUT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 E POST RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4607
Mailing Address - Country:US
Mailing Address - Phone:914-681-2430
Mailing Address - Fax:914-681-2941
Practice Address - Street 1:41 E POST RD
Practice Address - Street 2:ATTN: ADMINISTRATION
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4607
Practice Address - Country:US
Practice Address - Phone:914-681-1210
Practice Address - Fax:914-681-2839
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3344214363LF0000X
NY524378163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02665709Medicaid
NYA400066129Medicare PIN
NY02665709Medicaid