Provider Demographics
NPI:1376733998
Name:LAVIZZO MOUREY, RISA J (MD)
Entity Type:Individual
Prefix:DR
First Name:RISA
Middle Name:J
Last Name:LAVIZZO MOUREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 GEORGE STREET
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1311
Mailing Address - Country:US
Mailing Address - Phone:732-235-6700
Mailing Address - Fax:732-235-6726
Practice Address - Street 1:277 GEORGE STREET
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1311
Practice Address - Country:US
Practice Address - Phone:732-235-6700
Practice Address - Fax:732-235-6726
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07680700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7756801Medicaid