Individual
ELISABETH SUPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
335 MALCOLM X BLVD, NEW YORK, NY 10027-3703
(646) 585-1515
Mailing address
565 W 169TH ST APT 4A, NEW YORK, NY 10032-3909
(917) 673-5204
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
347779
NY
Other
Enumeration date
11/17/2021
Last updated
11/17/2021
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