Provider Demographics
NPI:1619132925
Name:KAYSER, LISA M (RPAC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:KAYSER
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:DELUCA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPAC
Mailing Address - Street 1:2 CORACI BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-4833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 CORACI BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-4833
Practice Address - Country:US
Practice Address - Phone:631-281-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011958363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant