Healthcare Provider Details

I. General information

NPI: 1689511081
Provider Name (Legal Business Name): LISA M. KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PLEASANT VALLEY WAY
WEST ORANGE NJ
07052-1424
US

IV. Provider business mailing address

66 BROOKLAWN DR
MORRIS PLAINS NJ
07950-3139
US

V. Phone/Fax

Practice location:
  • Phone: 973-731-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberNY807693
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: