Individual
MS. ELIZABETH WIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
177 FORT WASHINGTON AVENUE, MHB 7GN-435, NEW YORK, NY 10032
(212) 305-2633
Mailing address
941 GARDEN ST APT 3, HOBOKEN, NJ 07030-4299
(516) 383-5155
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
011195
NY
Other
Enumeration date
01/28/2009
Last updated
11/06/2020
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