Provider Demographics
NPI:1588720619
Name:LISH, KAREN MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MICHELLE
Last Name:LISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 FRANKLIN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1904
Mailing Address - Country:US
Mailing Address - Phone:516-374-7575
Mailing Address - Fax:516-374-7555
Practice Address - Street 1:301 FRANKLIN AVE STE 1
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1904
Practice Address - Country:US
Practice Address - Phone:516-374-7575
Practice Address - Fax:516-374-7555
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193905207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2K5292Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER
NYG28522Medicare UPIN