Individual
EDISERLIN LORA LIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2814 W 8TH ST APT 15C, BROOKLYN, NY 11224-3368
(347) 543-7367
Mailing address
78 5TH AVE FL 7, NEW YORK, NY 10011-8000
(212) 988-2924
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
942333124
LICENSE
NY
Enumeration date
11/19/2019
Last updated
07/19/2024
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