Healthcare Provider Details

I. General information

NPI: 1164105680
Provider Name (Legal Business Name): NATALIYA LIZANETS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SAINT GEORGES AVE STE 302
AVENEL NJ
07001-1330
US

IV. Provider business mailing address

1030 SAINT GEORGES AVE STE 302
AVENEL NJ
07001-1330
US

V. Phone/Fax

Practice location:
  • Phone: 732-750-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ14890400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ14890400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: