1073784294 NPI number — LISA KATHLEEN SIVIERI

Table of content: LISA KATHLEEN SIVIERI (NPI 1073784294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073784294 NPI number — LISA KATHLEEN SIVIERI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIVIERI
Provider First Name:
LISA
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIVIERI
Provider Other First Name:
LISA
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LAC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1073784294
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 HILLSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TURNERSVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08012-1813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-589-2948
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9101 CHERRY LN
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20708-1133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-490-9911
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  U01633 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)