Basic Information
| Provider Information | |||||||||
| NPI: | 1851026512 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SONGER | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | NOELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 548 DRUMM RD | ||||||||
| Address2: | |||||||||
| City: | WEBSTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145801577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5856453960 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2800 MAIN ST | ||||||||
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| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066064201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035766000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2022 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.