Provider Demographics
NPI:1437291408
Name:NOJAIM, LISA A (PA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:NOJAIM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 IRVING AVE
Mailing Address - Street 2:CROUSE PHYSICIANS OFFICE BLDG
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1603
Mailing Address - Country:US
Mailing Address - Phone:315-464-6395
Mailing Address - Fax:315-464-7238
Practice Address - Street 1:725 IRVING AVE
Practice Address - Street 2:CROUSE PHYSICIANS OFFICE BLDG
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1603
Practice Address - Country:US
Practice Address - Phone:315-464-6395
Practice Address - Fax:315-464-7238
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009773363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03214766Medicaid
NYJ400136338Medicare PIN