Provider Demographics
NPI:1194970715
Name:MANIATIS-FITTING, LISA B (MSN, ANP-C)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:B
Last Name:MANIATIS-FITTING
Suffix:
Gender:F
Credentials:MSN, ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2377 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-4413
Mailing Address - Country:US
Mailing Address - Phone:516-734-7000
Mailing Address - Fax:
Practice Address - Street 1:360 WASHINGTON AVE.
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575
Practice Address - Country:US
Practice Address - Phone:516-378-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003468-1225200000X
NYF307507-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health