Provider Demographics
NPI:1205015245
Name:IMPERANTE, LILLIAN (APN)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:IMPERANTE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:
Other - Last Name:STRUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:182 SOUTH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5377
Mailing Address - Country:US
Mailing Address - Phone:973-267-0300
Mailing Address - Fax:973-539-5401
Practice Address - Street 1:182 SOUTH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5377
Practice Address - Country:US
Practice Address - Phone:973-267-0300
Practice Address - Fax:973-695-1480
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO10875000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NO10875000OtherSTATE LICENSE