Provider Demographics
NPI:1447447859
Name:WIMBLEY, ELIZABETH MINAYA
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MINAYA
Last Name:WIMBLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 CORONA AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2923
Mailing Address - Country:US
Mailing Address - Phone:718-271-2020
Mailing Address - Fax:
Practice Address - Street 1:10401 CORONA AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2923
Practice Address - Country:US
Practice Address - Phone:718-271-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-29
Last Update Date:2007-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine