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General NPI Number Information
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NPI Number | 1093014458
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Entity Type | Individual
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Provider Name | YAAKOV Y LISS M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/23/2011
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 185 ROUTE 312
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City | BREWSTER
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State | NY
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Zip | 10509-2337
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Country | US
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Telephone | 845-278-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 110 S BEDFORD RD
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City | MOUNT KISCO
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State | NY
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Zip | 10549-3446
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Country | US
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Telephone | 914-241-1050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD456401
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 269206
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License Number State | NY
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