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General NPI Number Information
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NPI Number | 1588720619
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Entity Type | Individual
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Provider Name | KAREN MICHELLE LISH M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/01/2007
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 301 FRANKLIN AVE STE 1
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City | HEWLETT
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State | NY
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Zip | 11557-1904
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Country | US
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Telephone | 516-374-7575
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Fax | 516-374-7555
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Provider Business Mailing Address
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Address Line | 301 FRANKLIN AVE STE 1
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City | HEWLETT
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State | NY
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Zip | 11557-1904
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Country | US
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Telephone | 516-374-7575
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Fax | 516-374-7555
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 193905
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License Number State | NY
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