Healthcare Provider Details

I. General information

NPI: 1366238016
Provider Name (Legal Business Name): LISA RACHEL GEBIEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

2124 LINNEMAN ST
GLENVIEW IL
60025-4166
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-5026
  • Fax:
Mailing address:
  • Phone: 847-507-5472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: