Healthcare Provider Details

I. General information

NPI: 1144274309
Provider Name (Legal Business Name): LISA MICHELLE CHOLEFF D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA MICHELLE WASSERMAN D.O

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 10/05/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 HAZEN ST
EAST ELMHURST NY
11370-1381
US

IV. Provider business mailing address

1500 HAZEN ST
EAST ELMHURST NY
11370-1381
US

V. Phone/Fax

Practice location:
  • Phone: 347-774-8240
  • Fax:
Mailing address:
  • Phone: 347-774-8240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number197093
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: