Basic Information
| Provider Information | |||||||||
| NPI: | 1861408098 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LISHANSKY | ||||||||
| FirstName: | IZOLDA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 820933 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191820933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156771475 | ||||||||
| FaxNumber: | 2156773082 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 E ALLEGHENY AVE | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191344427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156771475 | ||||||||
| FaxNumber: | 2156773082 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 11/20/2013 | ||||||||
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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 | 207P00000X | MD37461E | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | MD037461E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0011979300001 | 05 | PA | MEDICAID | CD4829 | 01 | PA | TPI RAILROAD MEDICARE GROUP | OTHER | 1007278000 | 01 | PA | TPI MEDICAID GROUP | OTHER | 597586 | 01 | PA | TPI MEDICARE GROUP | OTHER |