Provider Demographics
NPI:1194922435
Name:LISS, MATTHEW JAY (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAY
Last Name:LISS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:30 ROCKEFELLER PLZ
Mailing Address - Street 2:NBCU MEDICAL DEPT., ROOM 750S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10112-0002
Mailing Address - Country:US
Mailing Address - Phone:212-664-2322
Mailing Address - Fax:212-664-5610
Practice Address - Street 1:30 ROCKEFELLER PLAZA
Practice Address - Street 2:NBCU MEDICAL DEPTROOM 750S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10112
Practice Address - Country:US
Practice Address - Phone:212-664-2322
Practice Address - Fax:212-664-5610
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY171959174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist