Individual
DIANE LYNN LISS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPA-C
Contact information
Practice address
87 W OLD COUNTRY RD, HICKSVILLE, NY 11801-4003
(516) 433-1100
(516) 433-1342
Mailing address
87 W OLD COUNTRY RD, HICKSVILLE, NY 11801-4003
(516) 433-1100
(516) 433-1342
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
005393-1
NY
Other
Enumeration date
01/31/2008
Last updated
01/31/2008
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