Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 042.0012118 | VT |
N | 207QS0010X | Family Doctor - Sports Medicine | 042.0012118 | VT |
NPI | 1174725303 |
---|---|
Provider Name | Dr. Timothy Stephen Lishnak |
First Address | Farmington, CT 06030-0001 |
Second Address | Farmington, CT 06030-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 01/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1174725303 | (05) | CT |
1174725303 | NPI (01) |