Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | F382436-1 | NY |
NPI | 1033551825 |
---|---|
Provider Name | Ms. Lisa Cordaro |
First Address | Hampton Bays, NY 11946-2011 |
Second Address | Hampton Bays, NY 11946-2011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2013 |
Last Update Date | 21/11/2019 |