Healthcare Provider Details

I. General information

NPI: 1205224136
Provider Name (Legal Business Name): MICHAEL LISKER L. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 E 21ST ST
BROOKLYN NY
11235-2913
US

IV. Provider business mailing address

2730 E 21ST ST
BROOKLYN NY
11235-2913
US

V. Phone/Fax

Practice location:
  • Phone: 917-406-3128
  • Fax: 718-715-1437
Mailing address:
  • Phone: 917-406-3128
  • Fax: 718-715-1437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number001735-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: