Provider Demographics
NPI:1801879564
Name:LISS, HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:
Last Name:LISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 DEAN DR STE 1
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2762
Mailing Address - Country:US
Mailing Address - Phone:201-390-9200
Mailing Address - Fax:201-871-2214
Practice Address - Street 1:111 DEAN DR STE 1
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2762
Practice Address - Country:US
Practice Address - Phone:201-390-9200
Practice Address - Fax:201-871-2214
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1323221208100000X
NJ25MA03903100208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ003227200OtherCDS
NJAL8085587OtherDEA
NJAL8085587OtherDEA