1265401699 NPI number — DR. LISA BARISCIANO M.D.

Table of content: DR. LISA BARISCIANO M.D. (NPI 1265401699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265401699 NPI number — DR. LISA BARISCIANO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARISCIANO
Provider First Name:
LISA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265401699
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 JAMES STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORHAM PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
09732-1346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-503-0600
Provider Business Mailing Address Fax Number:
973-503-0424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 JAMES STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORHAM PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
09732-1346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-503-0600
Provider Business Practice Location Address Fax Number:
973-503-0424
Provider Enumeration Date:
03/16/2006

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: 207K00000X , with the licence number:  MA075732 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0201X , with the licence number: MA075732 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: BEECH STREET . This is a "21247588446" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0009335992 . This is a "PHCS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7736574 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3238057 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K6693 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: CIGNA . This is a "4786617" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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