Barbara Teresa Licznerski, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

187504-1 Issued in NY

Practice address

826 Washington St
Suite 104
Watertown, NY 13601-4065

Phone

(315) 786-1500

Fax

(315) 786-2074

NPI assigned

Mar 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Dermatology & Plastic Surgery of Northern New York PC

  • Specialist
  • Watertown, NY
  • NPI 1598852329
  NPD (past) Authorized official

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407825151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "826 WASHINGTON ST",
            "address_2": "SUITE 104",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014065",
            "telephone_number": "315-786-1500",
            "fax_number": "315-786-2074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 WASHINGTON ST",
            "address_2": "SUITE 104",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014065",
            "telephone_number": "315-786-1500",
            "fax_number": "315-786-2074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICZNERSKI",
        "first_name": "BARBARA",
        "middle_name": "TERESA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "187504-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01563780",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "070012711",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NUMBER",
            "identifier": "AA0167",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristin M. Lewis, NP
• Rachel Ellen Lewis, M.D.
• Maksim Liaukovich, M.D.
• Liberty'S Angels Home Care Solution LLC
• Adam Bogdan Licznerski, MD
• Megan Liede
• Jennifer Liesen, MHC
• Chih-Wen Lin, AU.D.
• Lincare Inc.
• Beth Anne Linderman, LCSW

• Specialist in Watertown, NY
• Providers in Watertown, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.