Healthcare Provider Details

I. General information

NPI: 1194081653
Provider Name (Legal Business Name): LISA CAINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 10/18/2020
Certification Date: 10/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 E 43RD ST
BROOKLYN NY
11203-6507
US

IV. Provider business mailing address

730 E 43RD ST
BROOKLYN NY
11203-6507
US

V. Phone/Fax

Practice location:
  • Phone: 917-309-8145
  • Fax:
Mailing address:
  • Phone: 917-309-8145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number539842
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number306021
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: