Healthcare Provider Details

I. General information

NPI: 1659326924
Provider Name (Legal Business Name): CARA LYNN LISI MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 RICHMOND AVE
NEW MILFORD NJ
07646-2517
US

IV. Provider business mailing address

222 GATEWAY RD
RIDGEWOOD NJ
07450-2902
US

V. Phone/Fax

Practice location:
  • Phone: 201-907-3150
  • Fax: 201-907-3155
Mailing address:
  • Phone: 201-444-7416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00845900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number020026-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: