Provider Demographics
NPI:1326002171
Name:LASHIKER, LARISA (MD,)
Entity type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:LASHIKER
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 BAY RIDGE PKWY
Mailing Address - Street 2:APT B1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5943
Mailing Address - Country:US
Mailing Address - Phone:917-499-1055
Mailing Address - Fax:718-491-0991
Practice Address - Street 1:2061 BAY RIDGE PKWY
Practice Address - Street 2:APTB1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5943
Practice Address - Country:US
Practice Address - Phone:917-499-1055
Practice Address - Fax:718-491-0991
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231581208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02572301Medicaid
NY02572301Medicaid
NYL04214Medicare UPIN