Provider Demographics
NPI:1962841791
Name:KOERS, LISA K (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:KOERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 E 69TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5604
Mailing Address - Country:US
Mailing Address - Phone:646-697-9355
Mailing Address - Fax:646-697-9355
Practice Address - Street 1:436 E 69TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5604
Practice Address - Country:US
Practice Address - Phone:646-697-9355
Practice Address - Fax:646-697-0999
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01078260A207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300004243Medicaid