Provider Demographics
NPI:1457414815
Name:LINZER, LISA (DO)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:LINZER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3156 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-4838
Mailing Address - Country:US
Mailing Address - Phone:516-221-8678
Mailing Address - Fax:516-735-4971
Practice Address - Street 1:2920 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1402
Practice Address - Country:US
Practice Address - Phone:516-735-4949
Practice Address - Fax:516-735-4971
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198812208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics