Healthcare Provider Details

I. General information

NPI: 1396242590
Provider Name (Legal Business Name): LISA SERVENTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 US HIGHWAY 206 STE 2F
HILLSBOROUGH NJ
08844-4781
US

IV. Provider business mailing address

331 US HIGHWAY 206 STE 2F
HILLSBOROUGH NJ
08844-4781
US

V. Phone/Fax

Practice location:
  • Phone: 732-427-8102
  • Fax:
Mailing address:
  • Phone: 732-427-8102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA11552100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: