Boaz J Lissauer, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

208452 Issued in NY

Practice address

1036 Park Ave
Suite 1C
New York, NY 10028-0971

Phone

(212) 717-2150

Fax

(212) 717-2154

NPI assigned

Jun 13, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2017 through Jan 1, 2027

Specialty

OphthalmologyAlso: Plastic and Reconstructive Surgery

Education

George Washington University School of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Manhattan Oculofacial Plastic Surgery, PC

  • Ophthalmology Physician
  • New York, NY
  • NPI 1942412572
  Authorized official Same address or phone
• Lenox Hill Radiology & Medical Imaging Associates, PC

  • Diagnostic Radiology Physician
  • New York, NY
  • NPI 1821036807
  NPD (past)
• Manhattan Eye Ear and Throat Hospital

  • General Acute Care Hospital
  • New York, NY
  • NPI 1922169689
  NPD (past)
• New York Bone and Joint Specialists, PLLC

  • Physical Therapist
  • New York, NY
  • NPI 1811060619
  NPD (past)

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245888000000",
    "number": "1639173123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1036 PARK AVE",
            "address_2": "SUITE 1C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100280971",
            "telephone_number": "212-717-2150",
            "fax_number": "212-717-2154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1036 PARK AVE",
            "address_2": "SUITE 1C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100280971",
            "telephone_number": "212-717-2150",
            "fax_number": "212-717-2154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISSAUER",
        "first_name": "BOAZ",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-13",
        "last_updated": "2009-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "208452",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NJ",
            "license": "25MA07699200",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "NJ",
            "license": "25MA07699200",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "NY",
            "license": "208452",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLUE CROSS BLUE S",
            "identifier": "BL0482B310",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7554155",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "BL0482B310",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P2647045",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "0498250",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AFFNITY HEALTH PLAN",
            "identifier": "1000035875",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIP",
            "identifier": "208452",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DIVISION 1181 MAGNACARE",
            "identifier": "271252B",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Meredith I Liss, MA, RD, CDN
• Polina Liss
• Stephanie Liss, PA-C
• Brian M Lissak, LCSW
• Matthew Lissak, M.D.
• Jessica Lisser
• Rebecca Lisson
• Philip Bernard Listengart, PSYCHOANALYST
• Amanda Lister, PHD
• Elena Lister, M.D.

• Ophthalmology Physician in New York, NY
• Providers in New York, NY by specialty
• Ophthalmology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.