Clark, Lisa M

Clark, Lisa M is an individual health care provider with primary practice located at University Hosp Medical Center Stony Brk Dept Pediatrics Hsc 11Th Floor, Stony Brook NY 11794-0001. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Clark, Lisa M can be contacted via phone (631) 444-2967.

Contact Information

Primary practice address
University Hosp Medical Center Stony Brk Dept Pediatrics Hsc 11Th Floor Stony Brook NY 11794-0001
Phone: (631) 444-2967
Fax: (631) 444-6212
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 380567 New York

Profile Details

NPI number 1710146220
LBN Legal business name Clark, Lisa M
Credentials CPNP-AC
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 9th, 2008
Last updated Jun 9th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710146220 NPPES
New York Other 380567 NYS LICIENCE NUMBER

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