Provider Demographics
NPI:1932285814
Name:LISTER, PHILIP NATHANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:NATHANIEL
Last Name:LISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:905 FIFTH AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4156
Mailing Address - Country:US
Mailing Address - Phone:212-570-9441
Mailing Address - Fax:212-249-5666
Practice Address - Street 1:905 FIFTH AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10021-4156
Practice Address - Country:US
Practice Address - Phone:212-570-9441
Practice Address - Fax:212-249-5666
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1443762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry