Provider Demographics
NPI:1942499694
Name:LISA NAN FREEDMAN MD. PC.
Entity type:Organization
Organization Name:LISA NAN FREEDMAN MD. PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SIEW
Authorized Official - Middle Name:CHEAN
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-471-6442
Mailing Address - Street 1:5800 HERITAGE LANDING DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9378
Mailing Address - Country:US
Mailing Address - Phone:315-471-6442
Mailing Address - Fax:315-471-3074
Practice Address - Street 1:5800 HERITAGE LANDING DR
Practice Address - Street 2:SUITE B
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9378
Practice Address - Country:US
Practice Address - Phone:315-471-6442
Practice Address - Fax:315-471-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1854361207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0087Medicare PIN
NYE92562Medicare UPIN