Individual
LISA I THEBNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3415 BAINBRIDGE AVENUE, CHAM, BRONX, NY 10467
(718) 741-2150
Mailing address
24 ELDERBERRY LN, VALLEY STREAM, NY 11581-1739
(718) 741-2150
Taxonomy
Speciality
Code
Description
License number
State
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
221300
NY
Other
Enumeration date
01/04/2007
Last updated
07/08/2007
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