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General NPI Number Information
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NPI Number | 1215441423
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Entity Type | Organization
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Legal Business Name | LISA ROSE DURSO, MD PLLC
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Dates
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Enumeration Date | 11/27/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 30 E 60TH ST 808
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City | NEW YORK
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State | NY
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Zip | 10022-1008
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Country | US
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Telephone | 646-828-5756
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Fax | 844-742-8378
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Provider Business Mailing Address
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Address Line | 30 E 60TH ST 808
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City | NEW YORK
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State | NY
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Zip | 10022-1008
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MS. GIACINTA VITIELLO
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Credential |
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Telephone | 646-828-5756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State | NY
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