Healthcare Provider Details

I. General information

NPI: 1235073776
Provider Name (Legal Business Name): LISA EILEEN DORNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GARRET MOUNTAIN PLZ STE 400
WOODLAND PARK NJ
07424-3352
US

IV. Provider business mailing address

3 GARRET MOUNTAIN PLZ STE 400
WOODLAND PARK NJ
07424-3352
US

V. Phone/Fax

Practice location:
  • Phone: 973-256-4636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number26NJ15559700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: