MEDICARE: DR. LISA FLORENCE IMUNDO 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	2080P0216X	Pediatric Rheumatology Physician	180212-1	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	:	1881677763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA FLORENCE IMUNDO MD

Provider Business Mailing Address
First Line	:	161 FORT WASHINGTON AVE FL 2
Second Line	:	COLUMBIA UNIVERSITY
City	:	NEW YORK
State	:	NY
Zip	:	10032-3729
Country	:	US
Telephone Number	:	212-304-7250
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 FORT WASHINGTON AVE FL 2
Second Line	:	COLUMBIA UNIVERSITY DEPARTMENT OF PEDIATRICS
City	:	NEW YORK
State	:	NY
Zip	:	10032-3729
Country	:	US
Telephone Number	:	212-304-7250
Fax Number	:

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	11/24/2015

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