Healthcare Provider Details

I. General information

NPI: 1629849260
Provider Name (Legal Business Name): LISA HUANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MILLBURN AVE STE 203
MILLBURN NJ
07041-1933
US

IV. Provider business mailing address

3806 BOXWOOD CT
WHIPPANY NJ
07981-1763
US

V. Phone/Fax

Practice location:
  • Phone: 973-763-2555
  • Fax:
Mailing address:
  • Phone: 551-795-6974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ14983800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: