Provider Demographics
NPI:1205224136
Name:LISKER, MICHAEL (L AC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LISKER
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2913
Mailing Address - Country:US
Mailing Address - Phone:917-406-3128
Mailing Address - Fax:718-715-1437
Practice Address - Street 1:2730 E 21ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2913
Practice Address - Country:US
Practice Address - Phone:917-406-3128
Practice Address - Fax:718-715-1437
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001735-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist