Provider Demographics
NPI:1841569662
Name:MUSCARA, LISA MARIE
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:MUSCARA
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 1:1044 NORTHERN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1044 NORTHERN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1514
Practice Address - Country:US
Practice Address - Phone:516-801-6959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305883363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health