MEDICARE: GINA LUCIEN-LISSONE ANP

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	363LA2200X	Adult Health Nurse Practitioner	F302642	NY

General Provider Information

NPI Number	:	1669457289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA LUCIEN-LISSONE ANP

Provider Business Mailing Address
First Line	:	656 LENOX RD
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-1019
Country	:	US
Telephone Number	:	516-771-3756
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 PENN PLZ
Second Line	:	8TH FL
City	:	NEW YORK
State	:	NY
Zip	:	10119-0002
Country	:	US
Telephone Number	:	917-583-7878
Fax Number	:	866-491-2280

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	01/22/2016

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