Provider Demographics
NPI:1811959372
Name:HONKANEN, LISA A (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:HONKANEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 DALY RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-6308
Mailing Address - Country:US
Mailing Address - Phone:631-499-1236
Mailing Address - Fax:
Practice Address - Street 1:120 DALY RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-6308
Practice Address - Country:US
Practice Address - Phone:631-499-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211497207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02256086Medicaid
NYH63679Medicare UPIN
NYH63679Medicare UPIN