Provider Demographics
NPI:1386977510
Name:CHEVALIER FORGET, LISA MARIE (PA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:CHEVALIER FORGET
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:360 1ST AVE APT 6G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4920
Mailing Address - Country:US
Mailing Address - Phone:440-665-2408
Mailing Address - Fax:
Practice Address - Street 1:9 E 68TH ST STE 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4998
Practice Address - Country:US
Practice Address - Phone:212-575-1457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
NY013960363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical