Provider Demographics
NPI:1508064205
Name:MINSKY-PRIMUS, LISA (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:MINSKY-PRIMUS
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 1:205 W 86TH ST APT 112
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3391
Mailing Address - Country:US
Mailing Address - Phone:646-265-9349
Mailing Address - Fax:
Practice Address - Street 1:1324 LEXINGTON AVE
Practice Address - Street 2:SUITE 313
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1145
Practice Address - Country:US
Practice Address - Phone:646-740-4463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300000728Medicare Oscar/Certification
NYI01313Medicare UPIN