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NPI Code Detail

MEDICARE: MRS. LISA M. TKACHENKO PA-C

MEDICARE: MRS. LISA M. TKACHENKO PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantMA053629PA

General Provider Information

NPI Number : 1023268505
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA M. TKACHENKO PA-C
Provider Business Mailing Address
First Line : PO BOX 159
Second Line :
City : BARRINGTON
State : NJ
Zip : 08007-0159
Country : US
Telephone Number : 484-884-4500
Fax Number : 484-884-0699
Provider Business Practice Location Address
First Line : 410 N KROCKS RD
Second Line :
City : ALLENTOWN
State : PA
Zip : 18106-9283
Country : US
Telephone Number : 888-982-8594
Fax Number : 888-920-1525
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2008
Last Update Date : 07/31/2024

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