Individual provider Active NPI

Lisa Kirschbaum, MD

  • Internal Medicine Physician
  • Lake Success, NY
National Provider Identifier
1184651507
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
165854 Issued in NY
Practice address
2 Pro Health PLZ
Lake Success, NY 11042-1111
Phone
(516) 622-6020
NPI assigned
Jun 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 165854 NY Primary

Addresses

Primary practice location

2 Pro Health PLZ
Lake Success, NY 11042-1111

Mailing address

2 Pro Health PLZ
Lake Success, NY 11042-1111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040421001471 NY Practitioner - Internal Medicine 9537155908 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Urgent Care, PLLC CurrentSince Mar 1, 2020 Accepting new patients
Community Internal Medicine Assoc, PC Internal Medicine Past Accepting new patients

Locations

555 N Broadway
Jericho, NY 11753
Phone (516) 597-5070

2800 Marcus Ave
New Hyde Park, NY 11042
Phone (516) 622-6131

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184651507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 PRO HEALTH PLZ",
            "city": "LAKE SUCCESS",
            "state": "NY",
            "postal_code": "110421111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 PRO HEALTH PLZ",
            "city": "LAKE SUCCESS",
            "state": "NY",
            "postal_code": "110421111",
            "telephone_number": "516-622-6020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRSCHBAUM",
        "first_name": "LISA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "165854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Success, NY

Sources for this page

Verify at the official NPI Registry.