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General NPI Number Information
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NPI Number | 1588706725
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Entity Type | Organization
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Legal Business Name | XL-MED PC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 25-15 FAIR LAWN AVE
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City | FAIR LAWN
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State | NJ
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Zip | 07410-3434
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Country | US
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Telephone | 201-475-1005
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Fax | 201-475-1009
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Provider Business Mailing Address
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Address Line | 17-17 GREENWOOD DR
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City | FAIR LAWN
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State | NJ
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Zip | 07410-4533
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Country | US
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Telephone | 201-475-1005
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Fax | 201-475-1009
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OLGA LISHKO
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Credential | M.D.
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Telephone | 201-475-1005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MA67105
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License Number State | NJ
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