Provider Demographics
NPI:1548233679
Name:ZABELNY, LISA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:ZABELNY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ZABELNY
Other - Last Name:HAUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-1900
Mailing Address - Fax:585-922-1002
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:WILSON BUILDING
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3095
Practice Address - Country:US
Practice Address - Phone:585-922-4000
Practice Address - Fax:585-338-2997
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G53791Medicare UPIN