Provider Demographics
NPI:1790987485
Name:GINZLER, LISA JENNIFER
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:JENNIFER
Last Name:GINZLER
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 1:200 E 24TH ST
Mailing Address - Street 2:#401
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3916
Mailing Address - Country:US
Mailing Address - Phone:973-441-7741
Mailing Address - Fax:
Practice Address - Street 1:39 BROADWAY
Practice Address - Street 2:2115
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-3003
Practice Address - Country:US
Practice Address - Phone:212-422-9229
Practice Address - Fax:212-742-0928
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ052699-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist