Individual
LISSA SUGENG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, MPH
Contact information
Practice address
135 COLLEGE ST FL 3, SUITE 301, NEW HAVEN, CT 06510-2483
(203) 785-6460
Mailing address
P.O. BOX 208017, YALE SCHOOL OF MEDICINE, SECTION OF CARDIOLOGY, NEW HAVEN, CT 06520-8017
(203) 785-2469
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036098586
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036098586
—
IL
Enumeration date
12/18/2006
Last updated
10/25/2010
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