Provider Demographics
NPI:1811259450
Name:MICHAELOFF, LISA ANNE (MASPED)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANNE
Last Name:MICHAELOFF
Suffix:
Gender:F
Credentials:MASPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 LINFORD RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4930
Mailing Address - Country:US
Mailing Address - Phone:516-829-5949
Mailing Address - Fax:516-829-8805
Practice Address - Street 1:29 LINFORD RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4930
Practice Address - Country:US
Practice Address - Phone:516-829-5949
Practice Address - Fax:516-829-8805
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist