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MS. LISA MICHELLE TANNENBAUM PA-C
NPI 1114578507
Physician Assistant in Farmingville, NY

Active since September 26, 2019
100 GRANNY RD UNIT 2, FARMINGVILLE, NY 11738(631) 696-4357 Get Directions Write a Review

NPPES record last updated: September 26, 2019. Verified against the NPPES registry weekly; last sync: September 13, 2026.

About Ms. Lisa Michelle Tannenbaum Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. LISA MICHELLE TANNENBAUM PA-C (NPI 1114578507) is an individual physician assistant in Farmingville, New York, licensed in New York (1164958) and active in the NPI registry since September 2019.

NPPES Registry Identity

NPI1114578507
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameMS. LISA MICHELLE TANNENBAUMCredential: PA-C
Location Address100 GRANNY RD UNIT 2Farmingville, NY 11738-2879
Mailing Address8330 Kew Gardens Rd Apt 4kKew Gardens, NY 11415-1923 · (410) 910-0122
Phone(631) 696-4357
Sole ProprietorNo
Enumeration DateSeptember 26, 2019
✔ NPI 1114578507 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in NY · 1164958
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
100 GRANNY RD UNIT 2, Farmingville, NY 11738
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lisa Tannenbaum's NPI number?

The NPI number for Lisa Tannenbaum is 1114578507. It was assigned to this individual provider in the NPPES registry on September 26, 2019.

Where is Lisa Tannenbaum located?

Lisa Tannenbaum practices at 100 Granny Rd Unit 2, Farmingville, NY 11738. The listed phone number is (631) 696-4357.

What is Lisa Tannenbaum's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

When was this NPI record last updated?

The NPPES record for Lisa Tannenbaum was last updated on September 26, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.