Provider Demographics
NPI:1558638817
Name:INGLESE, LISA (CD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:INGLESE
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SUMMERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-5614
Mailing Address - Country:US
Mailing Address - Phone:631-905-5207
Mailing Address - Fax:
Practice Address - Street 1:20 SUMMERFIELD CT
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5614
Practice Address - Country:US
Practice Address - Phone:631-905-5207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula