Individual
DARIA ANN LISICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
240 RIVERSIDE DR., JOHNSON CITY, NY 13790-2732
(607) 798-9356
(607) 797-1707
Mailing address
5719 WIDEWATERS PKWY, SYRACUSE, NY 13214-1985
(315) 251-3105
(315) 449-9923
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
006573
NY
363A00000X
Physician Assistant
Primary
006573-1
NY
363AS0400X
Surgical Physician Assistant
006573
NY
363AS0400X
Surgical Physician Assistant
006573-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01793411
—
NY
Enumeration date
11/01/2006
Last updated
10/26/2016
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