Individual
LISA MA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
622 W 168TH ST, NEW YORK, NY 10032-3720
(212) 342-5525
Mailing address
24 SYCAMORE WAY, WARREN, NJ 07059-5674
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MA11125300
NJ
Other
Enumeration date
04/14/2016
Last updated
06/14/2022
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