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General NPI Number Information
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NPI Number | 1790753457
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Entity Type | Individual
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Provider Name | LISA CASSIDY NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 01/03/2014
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Provider Practice Location Address
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Address Line | 201 LYONS AVE SUITE G5
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City | NEWARK
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State | NJ
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Zip | 07112-2027
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Country | US
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Telephone | 973-926-7749
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Fax | 973-923-4683
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Provider Business Mailing Address
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Address Line | 201 LYONS AVE SUITE C1
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City | NEWARK
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State | NJ
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Zip | 07112-2027
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Country | US
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Telephone | 973-926-4430
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Fax | 973-926-5658
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 26NJ00075100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00075100
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License Number State | NJ
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