Provider Demographics
NPI:1851678825
Name:PULLMAN, LISA (LISA PULLMAN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:PULLMAN
Suffix:
Gender:F
Credentials:LISA PULLMAN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:PULLMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISA PULLMAN
Mailing Address - Street 1:57 LAKESHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5903
Mailing Address - Country:US
Mailing Address - Phone:516-804-9335
Mailing Address - Fax:
Practice Address - Street 1:2351 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1822
Practice Address - Country:US
Practice Address - Phone:516-608-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006004-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist