Provider Demographics
NPI:1376806885
Name:LISABERKINC
Entity Type:Organization
Organization Name:LISABERKINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CIOCI
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:516-729-0232
Mailing Address - Street 1:190 PARK LN
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4311
Mailing Address - Country:US
Mailing Address - Phone:516-729-0232
Mailing Address - Fax:
Practice Address - Street 1:190 PARK LN
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4311
Practice Address - Country:US
Practice Address - Phone:516-729-0232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty