Provider Demographics
NPI:1912334277
Name:CELLURA, LISA E
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:E
Last Name:CELLURA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:E
Other - Last Name:TOMPKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38 TALCOTT DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3706
Mailing Address - Country:US
Mailing Address - Phone:631-486-3885
Mailing Address - Fax:
Practice Address - Street 1:38 TALCOTT DR
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-3706
Practice Address - Country:US
Practice Address - Phone:631-486-3885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist