Provider Demographics
NPI:1932212701
Name:CALANDRA, LISA (DPM)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:CALANDRA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:55 WATER ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:4337 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-2411
Practice Address - Country:US
Practice Address - Phone:212-568-6300
Practice Address - Fax:212-544-5051
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO4874-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU33432Medicare UPIN
NY07623Medicare ID - Type Unspecified