Individual
MRS. ELIZABETH ROSE AHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPA-C
Contact information
Practice address
3384 ROUTE 22, PERU, NY 12972
(518) 643-8008
(518) 643-8090
Mailing address
60 AHERN RD, SARANAC, NY 12981-2719
(518) 293-7401
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
009293
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000416869005
BLUE SHIELD NENY
NY
05
—
02149273
—
NY
Enumeration date
09/20/2006
Last updated
08/24/2010
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