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NPI Code Detail

MEDICARE: MRS. LISA M BRUSCA PA

MEDICARE: MRS. LISA M BRUSCA PA
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
1363A00000XPhysician Assistant010935NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1010935OTHERNYNYS LICENSE

General Provider Information

NPI Number : 1528048246
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA M BRUSCA PA
Provider Business Mailing Address
First Line : 975 STEWART AVENUE
Second Line : CARDIOVASCULAR MEDICAL ASSOCIATES
City : GARDEN CITY
State : NY
Zip : 11530
Country : US
Telephone Number : 718-222-8600
Fax Number :
Provider Business Practice Location Address
First Line : 975 STEWART AVE
Second Line :
City : GARDEN CITY
State : NY
Zip : 11530-4816
Country : US
Telephone Number : 516-222-8600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2006
Last Update Date : 01/04/2012

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Directions to “ MRS. LISA M BRUSCA PA” Practice Location

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