Basic Information
| Provider Information | |||||||||
| NPI: | 1255437125 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIROTA | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 514 49TH ST | ||||||||
| Address2: | SUNSET TERRACE FAMILY HEALTH CENTER | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112202010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184372642 | ||||||||
| FaxNumber: | 7184375239 | ||||||||
| Practice Location | |||||||||
| Address1: | 514 49TH ST | ||||||||
| Address2: | SUNSET TERRACE FAMILY HEALTH CENTER | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112202010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184372642 | ||||||||
| FaxNumber: | 7184375239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 08/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 231277 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 02587180 | 05 | NY | MEDICAID |