MEDICARE: DR. LISA JOAN KALIK 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	207R00000X	Internal Medicine Physician	236978	NY

General Provider Information

NPI Number	:	1578772943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA JOAN KALIK M.D.

Provider Business Mailing Address
First Line	:	211 E 51ST ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-6526
Country	:	US
Telephone Number	:	212-398-1709
Fax Number	:

Provider Business Practice Location Address
First Line	:	2825 JACKSON AVE
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-2920
Country	:	US
Telephone Number	:	646-962-9921
Fax Number	:

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/04/2023

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