1659302925 NPI number — LISA FERRARO MD

Table of content: LISA FERRARO MD (NPI 1659302925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659302925 NPI number — LISA FERRARO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERRARO
Provider First Name:
LISA
Provider Middle Name:
Provider Name Prefix Text:
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:
1659302925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
414 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PATERSON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07501-2105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-742-1761
Provider Business Mailing Address Fax Number:
973-742-2033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
414 BROADWAY
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:
07501-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-742-1761
Provider Business Practice Location Address Fax Number:
973-742-2033
Provider Enumeration Date:
07/05/2006

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: 207R00000X , with the licence number:  MA050972 , 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)

  • Identifier: 398184 . This is a "WELLCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223425594 . This is a "HORIZON PROVIDER ID NUMBE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: J6378 . This is a "HORIZON HMO BLUE PROVIDER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1658905 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5187199002 . This is a "CIGNA HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01095174 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2864054001 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 90000300700 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 29EB21 . This is a "WELL CHOICE PROVIDER NUMB" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: PP188 . This is a "OXFORD PROVIDER NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 595703 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 25MA05097200ANE . This is a "HEALTHFIRST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 511952 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 713681 . This is a "HEALTH NET PROVIDER NUMBE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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