Provider Demographics
NPI:1225002009
Name:LISS, POLINA
Entity Type:Individual
Prefix:
First Name:POLINA
Middle Name:
Last Name:LISS
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 1:305 2ND AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2746
Mailing Address - Country:US
Mailing Address - Phone:212-375-0005
Mailing Address - Fax:212-505-6346
Practice Address - Street 1:305 2ND AVE STE 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2746
Practice Address - Country:US
Practice Address - Phone:212-375-0005
Practice Address - Fax:212-375-0004
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY51C311Medicare PIN
NYH03278Medicare UPIN