Provider Demographics
NPI:1477580058
Name:DALEY, LISA (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:DALEY
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 1:2154 NEWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-2239
Mailing Address - Country:US
Mailing Address - Phone:516-221-0225
Mailing Address - Fax:516-785-6210
Practice Address - Street 1:2154 NEWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-2239
Practice Address - Country:US
Practice Address - Phone:516-221-0225
Practice Address - Fax:516-785-6210
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202478208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG83291Medicare UPIN
NY11X401Medicare ID - Type Unspecified