Provider Demographics
NPI:1861737280
Name:TEPFER, LISA (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:TEPFER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:900 MERCHANTS CONCOURSE STE 216
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5114
Mailing Address - Country:US
Mailing Address - Phone:516-226-8373
Mailing Address - Fax:
Practice Address - Street 1:40 CROSSWAYS PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2038
Practice Address - Country:US
Practice Address - Phone:516-496-3900
Practice Address - Fax:516-496-9350
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337593363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner