Basic Information
Provider Information
NPI: 1295827335
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LISKER
FirstName: GITA
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 972 BRUSH HOLLOW RD
Address2: 4TH FLOOR
City: WESTBURY
State: NY
PostalCode: 115901740
CountryCode: US
TelephoneNumber: 5168765555
FaxNumber: 5168765539
Practice Location
Address1: 410 LAKEVILLE RD
Address2:  
City: NEW HYDE PARK
State: NY
PostalCode: 110421101
CountryCode: US
TelephoneNumber: 5164655400
FaxNumber: 5164655454
Other Information
ProviderEnumerationDate: 09/28/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001X227232NYY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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