Provider Demographics
NPI:1710958939
Name:LIZZA, ELI F (MD)
Entity Type:Individual
Prefix:
First Name:ELI
Middle Name:F
Last Name:LIZZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 54TH ST
Mailing Address - Street 2:2N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4707
Mailing Address - Country:US
Mailing Address - Phone:212-570-6800
Mailing Address - Fax:212-734-7425
Practice Address - Street 1:245 E 54TH ST
Practice Address - Street 2:2N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4707
Practice Address - Country:US
Practice Address - Phone:212-570-6800
Practice Address - Fax:212-734-7425
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1594941208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP450137OtherOXFORD
NY3S6291OtherEMPIRE BCBS ID
NY117206POtherHIP ID
NY47D991Medicare ID - Type UnspecifiedMEDICARE ID
NYP450137OtherOXFORD
NYA62920Medicare UPIN