Healthcare Provider Details

I. General information

NPI: 1457397861
Provider Name (Legal Business Name): JAY J LISKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 01/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 COMMUNITY DR SUITE 130
GREAT NECK NY
11021-5506
US

IV. Provider business mailing address

225 COMMUNITY DR SUITE 130
GREAT NECK NY
11021-5506
US

V. Phone/Fax

Practice location:
  • Phone: 516-504-0474
  • Fax: 516-504-0477
Mailing address:
  • Phone: 516-504-0474
  • Fax: 516-504-0477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number227230
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: