Provider Demographics
NPI:1114943552
Name:EILAND, LISA RENEE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:EILAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:PARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 PROSPECT AVENUE
Mailing Address - Street 2:WFAN BLDG PC218
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1915
Mailing Address - Country:US
Mailing Address - Phone:551-996-5362
Mailing Address - Fax:551-996-3232
Practice Address - Street 1:30 PROSPECT AVENUE
Practice Address - Street 2:WFAN BLDG PC218
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-0760
Practice Address - Country:US
Practice Address - Phone:551-996-5362
Practice Address - Fax:212-590-7800
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223303208000000X, 2080N0001X
NJ25MA115846002080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics