MEDICARE: DR. LISA HOLLY ABIS-VELASCO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	22DI01832100	NJ

General Provider Information

NPI Number	:	1306031224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA HOLLY ABIS-VELASCO DDS

Provider Business Mailing Address
First Line	:	47 ROMAR AVE
Second Line	:	BASEMENT
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-1834
Country	:	US
Telephone Number	:	201-985-8877
Fax Number	:	201-433-8289

Provider Business Practice Location Address
First Line	:	47 ROMAR AVE
Second Line	:	BASEMENT
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-1834
Country	:	US
Telephone Number	:	201-985-8877
Fax Number	:	201-433-8289

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	09/13/2007

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