Individual ProviderLisa PaulPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address475 Seaview Ave, Staten Island, NY 10305-3436(718) 226-9158(718) 761-0152PECOS EnrollmentBased on the most recent information from CMS, provider Lisa Paul is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1427230242Provider TypeIndividualFull NamePaul, LisaTitleMrs.CredentialPA - CGenderFemaleSole ProprietorNoEnumeration Date12/4/2007Last Updated10/28/2010Contact InformationPractice LocationPractice Address475 Seaview Ave, Staten Island, NY 10305-3436Phone(718) 226-9158Fax(718) 226-6964Mailing LocationMailing Address11 Spartan Ave, Staten Island, NY 10303-1728Phone(718) 761-0152FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense012296New YorkProvider IdentifiersIDDescriptionIssuerID03268077DescriptionMedicaidIssuerUnlistedNew York