Provider Demographics
NPI:1376584474
Name:LEDDEN, LISA (NP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:LEDDEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 LAKEWOOD RD STE 16
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-3287
Mailing Address - Country:US
Mailing Address - Phone:732-456-7777
Mailing Address - Fax:848-251-2189
Practice Address - Street 1:26 HIGHWAY 35 N
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:732-456-7777
Practice Address - Fax:848-251-2189
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00030100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9925222OtherAETNA PPO
NJP5985339OtherOXFORD
NJ1147464OtherAMERIGROUP
NJ334225OtherAMERICAID/AMERIGROUP
NJ3K3529OtherHEALTHNET
NJ153629C2HMedicare PIN
NJP3708651OtherOXFORD