Basic Information
| Provider Information | |||||||||
| NPI: | 1164482329 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARRERO | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 GUION PL | ||||||||
| Address2: | ISELIN HALL, ROOM 107 | ||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 108015503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146371357 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16 GUION PL | ||||||||
| Address2: | |||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 108015503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146325000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 10/10/2007 | ||||||||
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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 | 208000000X | 206871 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 01783004 | 05 | NY | MEDICAID |