Provider Demographics
NPI:1053650101
Name:SCHLOSSBERG, LISA MARIA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIA
Last Name:SCHLOSSBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WEST DR
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-3815
Mailing Address - Country:US
Mailing Address - Phone:631-375-7120
Mailing Address - Fax:
Practice Address - Street 1:28 WEST DR
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-3815
Practice Address - Country:US
Practice Address - Phone:631-375-7120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-10
Last Update Date:2013-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist