Provider Demographics
NPI:1851539514
Name:LARISSA LEMPERT MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LARISSA LEMPERT MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMPERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-633-3704
Mailing Address - Street 1:736 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6121
Mailing Address - Country:US
Mailing Address - Phone:718-874-0046
Mailing Address - Fax:347-586-0036
Practice Address - Street 1:736 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6121
Practice Address - Country:US
Practice Address - Phone:718-874-0046
Practice Address - Fax:347-586-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244026261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty