Provider Demographics
NPI:1558132977
Name:ROZBICKI, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ROZBICKI
Suffix:
Gender:F
Credentials:
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 328
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12542-0328
Mailing Address - Country:US
Mailing Address - Phone:845-656-8009
Mailing Address - Fax:
Practice Address - Street 1:21 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1332
Practice Address - Country:US
Practice Address - Phone:845-656-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies