Provider Demographics
NPI:1134694631
Name:LAPOMA, LISAMARIE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:LISAMARIE
Middle Name:
Last Name:LAPOMA
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:N MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1115
Mailing Address - Country:US
Mailing Address - Phone:516-330-4213
Mailing Address - Fax:
Practice Address - Street 1:150 HEWLETT AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3932
Practice Address - Country:US
Practice Address - Phone:516-379-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382899363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics