=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528039773
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN P LISSER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2006
-----------------------------------------------------
Last Update Date | 03/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 80 OAK HILL RD
-----------------------------------------------------
City | RED BANK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07701-5727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-741-2313
-----------------------------------------------------
Fax | 732-741-1952
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 80 OAK HILL RD
-----------------------------------------------------
City | RED BANK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07701-5727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-741-2313
-----------------------------------------------------
Fax | 732-741-1952
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0106X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Hand Surgery Physician
-----------------------------------------------------
License Number | 25MA06025200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | 25MA06025200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 25MA06025200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------