Healthcare Provider Details

I. General information

NPI: 1508362658
Provider Name (Legal Business Name): LILLIAN ALT MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 CHANGEBRIDGE RD
PINE BROOK NJ
07058-9839
US

IV. Provider business mailing address

330 CHANGEBRIDGE RD
PINE BROOK NJ
07058-9839
US

V. Phone/Fax

Practice location:
  • Phone: 973-830-9813
  • Fax:
Mailing address:
  • Phone: 973-830-9813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LILLIAN ALT
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 732-320-1888