Provider Demographics
NPI:1538586458
Name:ELIZABETH D. AVARICIO, MD, PLLC
Entity type:Organization
Organization Name:ELIZABETH D. AVARICIO, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:AVARICIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:546-591-4717
Mailing Address - Street 1:9511 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2500
Mailing Address - Country:US
Mailing Address - Phone:718-848-1806
Mailing Address - Fax:718-848-0569
Practice Address - Street 1:9511 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2500
Practice Address - Country:US
Practice Address - Phone:718-848-1806
Practice Address - Fax:718-848-0569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02367471Medicaid