Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 304988 | NY |
NPI | 1184917676 |
---|---|
Provider Name | Elizabeth Anne Lax |
First Address | Cooperstown, NY 13326-1394 |
Second Address | Cooperstown, NY 13326-1394 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2011 |
Last Update Date | 22/08/2020 |