Provider Demographics
NPI:1508866583
Name:LIS, JOANNA B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:B
Last Name:LIS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:970 41ST ST
Mailing Address - Street 2:SUITE # M1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-1114
Mailing Address - Country:US
Mailing Address - Phone:718-438-1322
Mailing Address - Fax:718-438-2295
Practice Address - Street 1:970 41ST ST
Practice Address - Street 2:SUITE # M1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-1114
Practice Address - Country:US
Practice Address - Phone:718-438-1322
Practice Address - Fax:718-438-2295
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2013-02-04
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Provider Licenses
StateLicense IDTaxonomies
NY213030208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H10710Medicare UPIN