Provider Demographics
NPI:1285982579
Name:GORDON-HANDLER, LISA F (OTR)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:F
Last Name:GORDON-HANDLER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TAMPA CT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-5214
Mailing Address - Country:US
Mailing Address - Phone:718-270-7735
Mailing Address - Fax:
Practice Address - Street 1:6 TAMPA CT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5214
Practice Address - Country:US
Practice Address - Phone:718-270-7735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006573174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist