1013907799 NPI number — DR. LISA LINER MD

Table of content: DR. LISA LINER MD (NPI 1013907799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013907799 NPI number — DR. LISA LINER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINER
Provider First Name:
LISA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1013907799
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E PENN SQ FL 9
Provider Second Line Business Mailing Address:
CHCA EMERGENCY MED
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-3377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-425-9232
Provider Business Mailing Address Fax Number:
267-425-9299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 BOWMAN DR
Provider Second Line Business Practice Location Address:
CHCA NJ EMERGENCY MED
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-9612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-772-0798
Provider Business Practice Location Address Fax Number:
609-261-5842
Provider Enumeration Date:
10/25/2005

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: 208000000X , with the licence number:  25MA07617500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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