Provider Demographics
NPI:1851491500
Name:LISZEWSKI, TIMOTHY PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PAUL
Last Name:LISZEWSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-2304
Mailing Address - Country:US
Mailing Address - Phone:518-842-1828
Mailing Address - Fax:518-842-8841
Practice Address - Street 1:279 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-2304
Practice Address - Country:US
Practice Address - Phone:518-842-1828
Practice Address - Fax:518-842-8841
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004673-1111NN0400X
SC1063111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurology
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10001201OtherCDPHP
NY10001201OtherCDPHP