Healthcare Provider Details

I. General information

NPI: 1952806796
Provider Name (Legal Business Name): LIZELLE COMFORT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MARCUS AVE STE M10C
NEW HYDE PARK NY
11042-2036
US

IV. Provider business mailing address

1111 MARCUS AVE STE M10C
NEW HYDE PARK NY
11042-2036
US

V. Phone/Fax

Practice location:
  • Phone: 516-266-3500
  • Fax:
Mailing address:
  • Phone: 516-266-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number316744
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: