Healthcare Provider Details

I. General information

NPI: 1578564266
Provider Name (Legal Business Name): LISA DABNEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W 59TH ST STE 5D OBGYN ASSOCIATES OF SLR
NEW YORK NY
10019-8022
US

IV. Provider business mailing address

PO BOX 95000-2243 OBGYN ASSOCIATES OF SLR
PHILADELPHIA PA
19195-2243
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-7570
  • Fax:
Mailing address:
  • Phone: 516-338-5300
  • Fax: 516-338-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number213835-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: