Provider Demographics
NPI:1497928931
Name:PEARSON, LISA MELNIK (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MELNIK
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29234
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-9234
Mailing Address - Country:US
Mailing Address - Phone:203-705-0715
Mailing Address - Fax:203-705-0717
Practice Address - Street 1:1 BLACHLEY RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-0002
Practice Address - Country:US
Practice Address - Phone:203-705-0715
Practice Address - Fax:203-705-0717
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3649363AM0700X, 363AS0400X
NY013905363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical