Provider Demographics
NPI:1609264324
Name:SINGH, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SINGH
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 1:721 43RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-3914
Mailing Address - Country:US
Mailing Address - Phone:646-298-4936
Mailing Address - Fax:
Practice Address - Street 1:888 FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-5907
Practice Address - Country:US
Practice Address - Phone:718-642-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY486525-1163WA0400X, 163WC1600X, 163WD0400X, 163WD1100X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal