Healthcare Provider Details

I. General information

NPI: 1194905133
Provider Name (Legal Business Name): LISA M FRIEDRICH APN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BAYBERRY LN
MOUNTAINSIDE NJ
07092-1401
US

IV. Provider business mailing address

2052 MORRIS AVE SUITE # 300
UNION NJ
07083-6028
US

V. Phone/Fax

Practice location:
  • Phone: 908-789-0471
  • Fax:
Mailing address:
  • Phone: 908-994-8880
  • Fax: 908-994-8882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NO09672100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ0016990
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: