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General NPI Number Information
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NPI Number | 1598817207
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Entity Type | Organization
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Legal Business Name | LISLE MEDICAL ARTS CENTER
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 66 JOHNSON HILL ROAD POB 338
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City | LISLE
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State | NY
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Zip | 13797-0338
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Country | US
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Telephone | 607-692-3844
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Fax | 607-692-3846
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Provider Business Mailing Address
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Address Line | 66 JOHNSON HILL ROAD POB 338
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City | LISLE
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State | NY
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Zip | 13797-0338
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Country | US
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Telephone | 607-692-3844
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Fax | 607-692-3846
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL J. DRISCOLL
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Credential | M.D.
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Telephone | 607-692-3844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 113141
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License Number State | NY
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