1649783556 NPI number — DR. ELIZABETH ANNE LAUBISCH PT, DPT

Table of content: DR. ELIZABETH ANNE LAUBISCH PT, DPT (NPI 1649783556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649783556 NPI number — DR. ELIZABETH ANNE LAUBISCH PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAUBISCH
Provider First Name:
ELIZABETH
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649783556
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 LEWIS RD
Provider Second Line Business Mailing Address:
2ND FL
Provider Business Mailing Address City Name:
BINGHAMTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-770-0025
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4433 VESTAL PKWY E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VESTAL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13850-3556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-762-2176
Provider Business Practice Location Address Fax Number:
607-762-2044
Provider Enumeration Date:
11/14/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  042546 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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