Basic Information
| Provider Information | |||||||||
| NPI: | 1942460365 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WIECHMANN | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | SILVIA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 161 FORT WASHINGTON AVE FL 10 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123059676 | ||||||||
| FaxNumber: | 2123051522 | ||||||||
| Practice Location | |||||||||
| Address1: | 161 FORT WASHINGTON AVE FL 10 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123059676 | ||||||||
| FaxNumber: | 2123051522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2008 | ||||||||
| LastUpdateDate: | 04/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | 249341 | NY | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 03135577 | 05 | NY | MEDICAID | P01822802 | 01 | NY | RAIL ROAD MEDICARE | OTHER | A400167592 | 01 | NY | NY MEDICARE PTAN | OTHER |