Provider Demographics
NPI:1265651988
Name:RANA, LISA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:RANA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HAMILTON AVE
Mailing Address - Street 2:APARTMENT 5B
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1840
Mailing Address - Country:US
Mailing Address - Phone:917-691-2613
Mailing Address - Fax:
Practice Address - Street 1:28 WARREN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-2216
Practice Address - Country:US
Practice Address - Phone:917-691-2613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003302171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist