Individual
DR. LISA MICHELLE WEDDERBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
2146 BEVERLEY RD, BROOKLYN, NY 11226-5406
(718) 210-3296
(877) 868-8633
Mailing address
722 E 51ST ST, BROOKLYN, NY 11203-5902
(917) 991-1279
(877) 868-8633
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
N005519
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02321319
—
NY
05
—
02519726
—
NY
Enumeration date
07/17/2006
Last updated
10/01/2008
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