Provider Demographics
NPI:1013105386
Name:CHRISTY, LISA MARIA (BA,SI)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIA
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:BA,SI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 STORM DR
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1921
Mailing Address - Country:US
Mailing Address - Phone:631-235-8962
Mailing Address - Fax:
Practice Address - Street 1:207 STORM DR
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1921
Practice Address - Country:US
Practice Address - Phone:631-235-8962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1914670171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor