Provider Demographics
NPI:1730234741
Name:KAREN M. LISH, M.D., P.C.
Entity type:Organization
Organization Name:KAREN M. LISH, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-374-7575
Mailing Address - Street 1:301 FRANKLIN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1904
Mailing Address - Country:US
Mailing Address - Phone:516-374-7575
Mailing Address - Fax:516-374-7555
Practice Address - Street 1:301 FRANKLIN AVE STE 1
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1904
Practice Address - Country:US
Practice Address - Phone:516-374-7575
Practice Address - Fax:516-374-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193905207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEB001Medicare ID - Type UnspecifiedGROUP NUMBER