Provider Demographics
NPI:1083711766
Name:LISH, ADAM J (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:J
Last Name:LISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1987 UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3215
Mailing Address - Country:US
Mailing Address - Phone:718-629-5590
Mailing Address - Fax:718-629-5590
Practice Address - Street 1:1901 UTICA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234
Practice Address - Country:US
Practice Address - Phone:718-968-8700
Practice Address - Fax:718-968-8743
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY189142207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01465690Medicaid
NY0147830001OtherNHIC
NY180029303OtherRAILROAD MEDICARE
NY01465690Medicaid
NY0147830001OtherNHIC