Individual provider Active NPI

Anna Marzena Lisowicz, NP

  • Adult Health Nurse Practitioner
  • Forest Hills, NY
National Provider Identifier
1275968364
Registry record updated Sep 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F306357-1 Issued in NY
Practice address
10201 66TH Rd
Forest Hills, NY 11375-2029
Phone
(718) 830-4000
NPI assigned
Sep 7, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F306357-1 NY Primary
Gerontology Nurse Practitioner 363LG0600X F340886-1 NY

Addresses

Primary practice location

10201 66TH Rd
Forest Hills, NY 11375-2029

Mailing address

6163 56TH St
Apt. 2ND Floor
Maspeth, NY 11378-3529
Phone (347) 420-9557

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200423002104 NY Practitioner - Nurse Practitioner 1759711203 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F306357-1NYMDAdult Health Nurse Practitioner
F340886-1NYMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Jan 10, 2023 Accepting new patients
North Shore - Lij Medical PC CurrentSince Jan 10, 2023 Accepting new patients

Locations

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

300 Community Dr
Plandome, NY 11030

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

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": "1378512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378512000000",
    "number": "1275968364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6163 56TH ST",
            "address_2": "APT. 2ND FLOOR",
            "city": "MASPETH",
            "state": "NY",
            "postal_code": "113783529",
            "telephone_number": "347-420-9557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10201 66TH RD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113752029",
            "telephone_number": "718-830-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISOWICZ",
        "first_name": "ANNA",
        "middle_name": "MARZENA",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-07",
        "last_updated": "2013-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F306357-1",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NY",
            "license": "F340886-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

Verify at the official NPI Registry.