Provider Demographics
NPI:1427201607
Name:DREYFUSS, LISA ELLEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ELLEN
Last Name:DREYFUSS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:ELLEN
Other - Last Name:DREYFUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:117 WHITE HORSE ROAD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2601
Mailing Address - Country:US
Mailing Address - Phone:859-435-4000
Mailing Address - Fax:856-435-6866
Practice Address - Street 1:117 WHITE HORSE ROAD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2601
Practice Address - Country:US
Practice Address - Phone:856-435-4000
Practice Address - Fax:856-435-6866
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00255900213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U68408Medicare UPIN
036805MU9Medicare PIN