Provider Demographics
NPI:1992044218
Name:CELLURA, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CELLURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8309
Mailing Address - Country:US
Mailing Address - Phone:631-813-1112
Mailing Address - Fax:631-206-9200
Practice Address - Street 1:2 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8309
Practice Address - Country:US
Practice Address - Phone:631-813-1112
Practice Address - Fax:631-206-9200
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008166-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician