Healthcare Provider Details

I. General information

NPI: 1457498685
Provider Name (Legal Business Name): LISA DEUTSCHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W END AVE SUITE 1D
NEW YORK NY
10024-5358
US

IV. Provider business mailing address

440 W END AVE SUITE 1D
NEW YORK NY
10024-5358
US

V. Phone/Fax

Practice location:
  • Phone: 212-501-0726
  • Fax:
Mailing address:
  • Phone: 212-501-0726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number166384
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: