Provider Demographics
NPI:1790153260
Name:BRISKA, LISA A
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:BRISKA
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 1:717 S OYSTER BAY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3305
Mailing Address - Country:US
Mailing Address - Phone:516-238-1469
Mailing Address - Fax:
Practice Address - Street 1:717 S OYSTER BAY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-3305
Practice Address - Country:US
Practice Address - Phone:516-238-1469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175830146M00000X
NY572645163WC0400X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
No163WC0400XNursing Service ProvidersRegistered NurseCase Management