Healthcare Provider Details

I. General information

NPI: 1710958939
Provider Name (Legal Business Name): ELI F LIZZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 E 54TH ST 2N
NEW YORK NY
10022-4707
US

IV. Provider business mailing address

245 E 54TH ST 2N
NEW YORK NY
10022-4707
US

V. Phone/Fax

Practice location:
  • Phone: 212-570-6800
  • Fax: 212-734-7425
Mailing address:
  • Phone: 212-570-6800
  • Fax: 212-734-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number1594941
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: