Healthcare Provider Details

I. General information

NPI: 1134240641
Provider Name (Legal Business Name): LISA PLANETA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E 70TH ST STARR PAVILION, ROOM 409
NEW YORK NY
10021-9800
US

IV. Provider business mailing address

7235 67TH PL
GLENDALE NY
11385-6956
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-2158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF304289-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: