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Individual
LISA R BARDACK
Active
Individual
LISA R BARDACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
187980
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01435758
—
NY
01
—
0667910001
DME
NY
01
—
110153364
MEDICARE RAILROAD
NY
Enumeration date
05/10/2006
Last updated
11/11/2016
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