Healthcare Provider Details

I. General information

NPI: 1538255377
Provider Name (Legal Business Name): LISA ANN MCCARTHY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 STONELEIGH AVE STE 111
CARMEL NY
10512-2455
US

IV. Provider business mailing address

19 PARK HILL TER
MAHOPAC NY
10541-3048
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-9652
  • Fax: 845-279-3606
Mailing address:
  • Phone: 845-621-9799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF381445
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number381445
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: