=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467267450
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LILIBET MARIA PLASENCIA PHYSICIAN ASSISTANT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2025
-----------------------------------------------------
Last Update Date | 04/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 ROOSEVELT AVE APT V10
-----------------------------------------------------
City | CARTERET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07008-3483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 848-250-2017
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 ROUTE 17 STE 501
-----------------------------------------------------
City | RUTHERFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07070-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-457-0044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 25MP00914800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | 25MP00914800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------