Basic Information
| Provider Information | |||||||||
| NPI: | 1154397867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZAMBRON | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2128 ELMWOOD AVENUE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168744500 | ||||||||
| FaxNumber: | 7168748145 | ||||||||
| Practice Location | |||||||||
| Address1: | 2128 ELMWOOD AVENUE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168744500 | ||||||||
| FaxNumber: | 7168748145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 09/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0198871 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 000625830001 | 01 | COMMUNITY BLUE | OTHER | 000625830001 | 01 | CB ADVANTAGE | OTHER | 000625830001 | 01 | CB LABOR HEALTH | OTHER | 01465154 | 05 | NY | MEDICAID | 000625830001 | 01 | BCBS | OTHER | 000625830001 | 01 | CHILD HEALTH PLUS | OTHER |