Provider Demographics
NPI:1043293863
Name:COLON-LIZ, DELFINA ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:DELFINA
Middle Name:ELIZABETH
Last Name:COLON-LIZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SHORT ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4012
Mailing Address - Country:US
Mailing Address - Phone:917-519-6371
Mailing Address - Fax:
Practice Address - Street 1:3467 DEKALB AVE APT 1G
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2322
Practice Address - Country:US
Practice Address - Phone:718-994-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04429611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01364070Medicaid