Provider Demographics
NPI:1659478691
Name:DEFALCO, LISA MAY (DO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MAY
Last Name:DEFALCO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:653 WILLOW GROVE ST
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-1732
Mailing Address - Country:US
Mailing Address - Phone:908-852-7770
Mailing Address - Fax:908-852-7755
Practice Address - Street 1:653 WILLOW GROVE ST
Practice Address - Street 2:SUITE 2200
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1732
Practice Address - Country:US
Practice Address - Phone:908-852-7770
Practice Address - Fax:908-852-7755
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMB077754207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH71213Medicare UPIN