Provider Demographics
NPI:1912004144
Name:NEAL M. LISANN, M.D., P.C.
Entity Type:Organization
Organization Name:NEAL M. LISANN, M.D., P.C.
Other - Org Name:EMPIRE MEDICAL DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LISANN, M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:718-953-4000
Mailing Address - Street 1:290 EMPIRE BLVD
Mailing Address - Street 2:SUITE 5G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3551
Mailing Address - Country:US
Mailing Address - Phone:718-953-4000
Mailing Address - Fax:718-953-4001
Practice Address - Street 1:290 EMPIRE BLVD
Practice Address - Street 2:SUITE 5G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3551
Practice Address - Country:US
Practice Address - Phone:718-953-4000
Practice Address - Fax:718-953-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB17098Medicare UPIN
NYW23002Medicare PIN