Lisella, Jordan M

Lisella, Jordan M is an individual health care provider with primary practice located at 1367 Washington Ave Suite 200, Albany NY 12206-1069. He recently has only one registered license in Allopathic & Osteopathic Physicians / Foot and Ankle Surgery, which is considered as his primary health care specialty. Lisella, Jordan M can be contacted via phone (518) 489-2666.

Contact Information

Primary practice address
1367 Washington Ave Suite 200 Albany NY 12206-1069
Phone: (518) 489-2666
Fax: (518) 489-5933
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Foot and Ankle Surgery 207XX0004X 4301087211 Michigan

Profile Details

NPI number 1720043946
LBN Legal business name Lisella, Jordan M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 19th, 2006
Last updated Feb 28th, 2008 - about 17 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 1720043946 NPPES
New York MEDICAID 02865736

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