Healthcare Provider Details

I. General information

NPI: 1518901503
Provider Name (Legal Business Name): LISA CARABELLI HURCKES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. LISA DEBLOIS CARABELLI

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 FARRINGTON ST
VAUXHALL NJ
07088-1307
US

IV. Provider business mailing address

99 BEAUVOIR AVE OVERLOOK MEDICAL CENTER, DEPARTMENT OF MEDICINE
SUMMIT NJ
07901-3533
US

V. Phone/Fax

Practice location:
  • Phone: 908-598-7950
  • Fax: 908-686-1163
Mailing address:
  • Phone: 973-309-4260
  • Fax: 908-273-7230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06101400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: