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General NPI Number Information
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NPI Number | 1447902150
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Entity Type | Individual
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Provider Name | CASSANDRA LEE LIDISKY PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 160 E 56TH ST FL 12
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City | NEW YORK
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State | NY
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Zip | 10022-3609
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Country | US
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Telephone | 212-457-1722
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Fax | 917-388-2105
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Provider Business Mailing Address
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Address Line | 109 E 2ND ST APT 9
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City | NEW YORK
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State | NY
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Zip | 10009-7975
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Country | US
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Telephone | 832-585-3808
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 027884
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License Number State | NY
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