Provider Demographics
NPI:1578818068
Name:POGONOWSKI, ELIZABETH M (PT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:M
Last Name:POGONOWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:M
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2050 TILDEN AVE
Mailing Address - Street 2:P.O. BOX 1000
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-3613
Mailing Address - Country:US
Mailing Address - Phone:315-797-3114
Mailing Address - Fax:315-624-0474
Practice Address - Street 1:2050 TILDEN AVE
Practice Address - Street 2:BOX 1000
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-3613
Practice Address - Country:US
Practice Address - Phone:315-797-3114
Practice Address - Fax:315-624-0474
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7876283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01815443Medicaid
NY00313539Medicaid
NY01815443Medicaid
NY334526Medicare Oscar/Certification