Healthcare Provider Details

I. General information

NPI: 1699425629
Provider Name (Legal Business Name): LISA BARMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 TROWBRIDGE DR
RANDOLPH NJ
07869-4519
US

IV. Provider business mailing address

12 RIVERSIDE DR
DENVILLE NJ
07834-2133
US

V. Phone/Fax

Practice location:
  • Phone: 917-653-5103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number647218
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: