Provider Demographics
NPI:1326454372
Name:JOHN, LIZA
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:JOHN
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 1:97 BEAUMONT CIR
Mailing Address - Street 2:APT-1
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-2032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:97 BEAUMONT CIR
Practice Address - Street 2:APT-1
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-2032
Practice Address - Country:US
Practice Address - Phone:914-346-5868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337890-1282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access