Provider Demographics
NPI:1316180755
Name:ABATE, LISA MARIE
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:ABATE
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 1:192 GLENWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-2542
Mailing Address - Country:US
Mailing Address - Phone:609-267-5656
Mailing Address - Fax:
Practice Address - Street 1:1289 ROUTE 38
Practice Address - Street 2:
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036-2730
Practice Address - Country:US
Practice Address - Phone:609-267-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJS-4286174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist