Provider Demographics
NPI:1235603895
Name:CARLOMAGNO, LISA COLLEEN
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:COLLEEN
Last Name:CARLOMAGNO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 SCHARER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-1814
Mailing Address - Country:US
Mailing Address - Phone:201-873-7860
Mailing Address - Fax:
Practice Address - Street 1:10 LINK DR
Practice Address - Street 2:
Practice Address - City:ROCKLEIGH
Practice Address - State:NJ
Practice Address - Zip Code:07647-2504
Practice Address - Country:US
Practice Address - Phone:201-784-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ466TR00199200225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation