Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X008364-1 | NY |
NPI | 1003134255 |
---|---|
Provider Name | Dr. Donald L Liss |
First Address | Brentwood, NY 11717-4611 |
Second Address | Brentwood, NY 11717-4611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2010 |
Last Update Date | 12/05/2010 |