Healthcare Provider Details

I. General information

NPI: 1407021132
Provider Name (Legal Business Name): KERI ELIZABETH LUNSFORD M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BERGEN ST # E1650
NEWARK NJ
07103
US

IV. Provider business mailing address

30 BERGEN ST RM 1205
NEWARK NJ
07107-3000
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-7218
  • Fax: 973-972-2988
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA10654300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number25MA10654300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: