Lisa Bruefach, RPA-C
Individual provider Active NPI Medical Physician Assistant · Roslyn, NY
NPI 1245458223 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1245458223
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 005205 (NY)
- Practice address
- 100 Port Washington Blvd
Roslyn, NY 11576-1353 - Phone
- (516) 562-6602
- Fax
- (516) 562-6614
- NPI assigned
- Apr 23, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005205 | NY | MD | Medical Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 005205 | NY | Yes |
Addresses
Primary practice location
100 Port Washington Blvd
Roslyn, NY 11576-1353
Mailing address
221 Harbor Hill Rd
Roslyn, NY 11576-2209
Phone (516) 484-1904
Other providers in Roslyn, NY
- Meaghan Brennan
- Patrick Brennan
- Alexandra Broccolo
- Olivia D Brown
- Stuart Brown
- Jessica Brutus
- Bryant Chemists Inc
- Lisa Burke
- David Burstein
- Brian Jonathan Butler
All providers in Roslyn, NY · Medical Physician Assistant in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.