Healthcare Provider Details

I. General information

NPI: 1538379052
Provider Name (Legal Business Name): LISA DIANE ZELNICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE BELLEVUE HOSPITAL CENTER
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

462 FIRST AVENUE BELLEVUE HOSPITAL CENTER,
NEW YORK NY
10016
US

V. Phone/Fax

Practice location:
  • Phone: 212-562-5278
  • Fax: 212-562-8537
Mailing address:
  • Phone: 718-920-6378
  • Fax: 212-562-8537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number236359-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: