Healthcare Provider Details

I. General information

NPI: 1386816791
Provider Name (Legal Business Name): LISA ANN LOEFFLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E 61ST ST
NEW YORK NY
10065-8102
US

IV. Provider business mailing address

106 E 61ST ST
NEW YORK NY
10065-8102
US

V. Phone/Fax

Practice location:
  • Phone: 212-794-2500
  • Fax: 212-879-3846
Mailing address:
  • Phone: 212-794-2500
  • Fax: 212-879-3846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number251213
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number046259
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: