Provider Demographics
NPI:1477508570
Name:LINDQUIST, LISA ANN (DO)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:LINDQUIST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SPRING GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2516
Mailing Address - Country:US
Mailing Address - Phone:609-561-1700
Mailing Address - Fax:856-346-1052
Practice Address - Street 1:301 SPRING GARDEN RD
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2516
Practice Address - Country:US
Practice Address - Phone:609-561-1700
Practice Address - Fax:856-346-1052
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB560682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5574404Medicaid
NJ25MB05606800OtherNJ MEDICAL LICENSE
NJF60522Medicare UPIN
NJ5574404Medicaid