Provider Demographics
NPI:1194843292
Name:PRESTON, LISA MEREDITH (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MEREDITH
Last Name:PRESTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 8TH AVE UNIT 7004
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10116-8963
Mailing Address - Country:US
Mailing Address - Phone:917-338-1884
Mailing Address - Fax:
Practice Address - Street 1:224 WEST 35TH ST
Practice Address - Street 2:12TH FLOOR, UNIT 5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:917-338-1884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252268207P00000X, 207R00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine