Provider Demographics
NPI:1194934042
Name:LEPORE, LISA ANN (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:LEPORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ANDOVER DR
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3014
Mailing Address - Country:US
Mailing Address - Phone:631-473-5540
Mailing Address - Fax:
Practice Address - Street 1:18 ANDOVER DR
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3014
Practice Address - Country:US
Practice Address - Phone:631-474-1743
Practice Address - Fax:631-474-1770
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006301-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX5840Medicare PIN