Individual
FAUSTO GABRIEL LISUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 E 77TH ST, NEW YORK, NY 10075-1850
(212) 434-2000
Mailing address
100 E 77TH ST, NEW YORK, NY 10075-1850
(212) 434-2000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
280567
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA09737400
NJ STATE
NJ
01
—
280567
NY STATE
NY
Enumeration date
08/27/2012
Last updated
08/11/2015
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