Healthcare Provider Details

I. General information

NPI: 1114943552
Provider Name (Legal Business Name): LISA RENEE EILAND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA PARTIN

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVENUE WFAN BLDG PC218
HACKENSACK NJ
07601-0760
US

IV. Provider business mailing address

30 PROSPECT AVENUE WFAN BLDG PC218
HACKENSACK NJ
07601-1915
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-5362
  • Fax: 212-590-7800
Mailing address:
  • Phone: 551-996-5362
  • Fax: 551-996-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number223303
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number223303
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number25MA11584600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: