MEDICARE: LISA S. PHILLIPS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	209718	NY
2	207L00000X	Anesthesiology Physician	209718-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083610968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA S. PHILLIPS M.D.

Provider Business Mailing Address
First Line	:	100 PORT WASHINGTON BLVD
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576-1353
Country	:	US
Telephone Number	:	516-627-6624
Fax Number	:	516-627-3804

Provider Business Practice Location Address
First Line	:	100 PORT WASHINGTON BLVD
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576-1353
Country	:	US
Telephone Number	:	516-627-6624
Fax Number	:	516-627-3804

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	08/24/2010

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