Provider Demographics
NPI:1326123266
Name:LISTER, ELENA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:LISTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E 91ST ST # 6FG
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5895
Mailing Address - Country:US
Mailing Address - Phone:917-414-5703
Mailing Address - Fax:212-249-5666
Practice Address - Street 1:333 E 91ST ST # 6FG
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5895
Practice Address - Country:US
Practice Address - Phone:917-414-5703
Practice Address - Fax:212-249-5666
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1559272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry