Provider Demographics
NPI:1447052527
Name:MORDELL, LISA JEAN
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JEAN
Last Name:MORDELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 5TH AVE
Mailing Address - Street 2:PO BOX 1170
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-0312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1176 5TH AVE
Practice Address - Street 2:PO BOX 1170
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-0312
Practice Address - Country:US
Practice Address - Phone:212-241-8528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program