Provider Demographics
NPI:1699108332
Name:LISKER, YEHUDA (OTR)
Entity type:Individual
Prefix:MR
First Name:YEHUDA
Middle Name:
Last Name:LISKER
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-4131
Mailing Address - Country:US
Mailing Address - Phone:201-723-7228
Mailing Address - Fax:
Practice Address - Street 1:536 WINDSOR RD
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-4131
Practice Address - Country:US
Practice Address - Phone:201-723-7228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018035-1225X00000X
NJ46TR00616300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist