MEDICARE: ELI F LIZZA MD

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	208800000X	Urology Physician	1594941	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P450137	OTHER	NY	OXFORD
2	3S6291	OTHER	NY	EMPIRE BCBS ID
3	117206P	OTHER	NY	HIP ID

General Provider Information

NPI Number	:	1710958939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELI F LIZZA MD

Provider Business Mailing Address
First Line	:	245 E 54TH ST
Second Line	:	2N
City	:	NEW YORK
State	:	NY
Zip	:	10022-4707
Country	:	US
Telephone Number	:	212-570-6800
Fax Number	:	212-734-7425

Provider Business Practice Location Address
First Line	:	245 E 54TH ST
Second Line	:	2N
City	:	NEW YORK
State	:	NY
Zip	:	10022-4707
Country	:	US
Telephone Number	:	212-570-6800
Fax Number	:	212-734-7425

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	11/09/2016

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Directions to “ ELI F LIZZA MD” Practice Location

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