Provider Demographics
NPI:1982168290
Name:SMITH, LISA LYNN
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 CENTRAL PARK AVENUE, SUITE 304
Mailing Address - Street 2:
Mailing Address - City:SEARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583
Mailing Address - Country:US
Mailing Address - Phone:914-472-2600
Mailing Address - Fax:914-722-1763
Practice Address - Street 1:531 CENTRAL PARK AVENUE, SUITE 304
Practice Address - Street 2:
Practice Address - City:SEARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583
Practice Address - Country:US
Practice Address - Phone:914-472-2600
Practice Address - Fax:914-722-1763
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006137171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist