Provider Demographics
NPI:1316401516
Name:LISIK-ROBERTI CLINICAL MEDICINE LLC
Entity Type:Organization
Organization Name:LISIK-ROBERTI CLINICAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHANTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:LISIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-868-6669
Mailing Address - Street 1:67 WALNUT AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1687
Mailing Address - Country:US
Mailing Address - Phone:732-499-9110
Mailing Address - Fax:855-822-3223
Practice Address - Street 1:67 WALNUT AVE STE 402
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1687
Practice Address - Country:US
Practice Address - Phone:732-499-9110
Practice Address - Fax:855-822-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty