Provider Demographics
NPI:1033304779
Name:ZDINAK, LISA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
Last Name:ZDINAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E 74TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3272
Mailing Address - Country:US
Mailing Address - Phone:212-799-1411
Mailing Address - Fax:212-288-3746
Practice Address - Street 1:135 E 74TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3272
Practice Address - Country:US
Practice Address - Phone:212-799-1411
Practice Address - Fax:212-288-3746
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234725207W00000X
NJ25M07927500207W00000X
FLME97652207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI34112Medicare UPIN