1083673479 NPI number — DR. LISA MARIE SHEPPARD MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083673479 NPI number — DR. LISA MARIE SHEPPARD MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SHEPPARD

Provider First Name:

LISA MARIE

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

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:

1083673479

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/21/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

31 PARK HILL TERRACE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PRINCETON JUNCTION

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

08550-1944

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

908-284-2300

Provider Business Mailing Address Fax Number:

908-442-7432

Provider First Line Business Practice Location Address:

680 BROADWAY STE 111

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

PATERSON

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

07514-1526

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

973-977-6662

Provider Business Practice Location Address Fax Number:

973-341-1128

Provider Enumeration Date:

03/23/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  039123 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 209589 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: ME75363 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: CI0007032 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: M8820 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 01048566A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 015679 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 00057528 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 0474456 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 10311 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 11256 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: MA53519 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 179324-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 10485 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: MD044023E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 02636560 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 001969572 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 7314701 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 2863049 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 0157457 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 015745700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 200262470 A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
• Identifier: 200933310 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
• Identifier: 1451789 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
• Identifier: 7100070710 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: 7725960 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".