Provider Demographics
NPI:1841330495
Name:BADRI, LISA (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:BADRI
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:ROOPNARINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:101 MONTEREY DR
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1053
Mailing Address - Country:US
Mailing Address - Phone:646-302-0722
Mailing Address - Fax:
Practice Address - Street 1:270-05 76TH AVENUE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1433
Practice Address - Country:US
Practice Address - Phone:718-470-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008682363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical