Provider Demographics
NPI:1700271020
Name:LISA A NELSON NP-PSYCHIATRY
Entity Type:Organization
Organization Name:LISA A NELSON NP-PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:516-639-5109
Mailing Address - Street 1:3771 NESCONSET HWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1163
Mailing Address - Country:US
Mailing Address - Phone:631-689-5390
Mailing Address - Fax:631-689-5395
Practice Address - Street 1:3771 NESCONSET HWY
Practice Address - Street 2:SUITE 212
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1163
Practice Address - Country:US
Practice Address - Phone:631-689-5390
Practice Address - Fax:631-689-5395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401077163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCCCCCMedicare PIN