Provider Demographics
NPI:1497756589
Name:STEVENS, LISA DEBORAH (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DEBORAH
Last Name:STEVENS
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 1:1777 HAMBURG TURNPIKE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5243
Mailing Address - Country:US
Mailing Address - Phone:973-839-6400
Mailing Address - Fax:973-839-7083
Practice Address - Street 1:1777 HAMBURG TURNPIKE
Practice Address - Street 2:SUITE 305
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5243
Practice Address - Country:US
Practice Address - Phone:973-839-6400
Practice Address - Fax:973-839-7083
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07080100207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H18397Medicare UPIN
NJST038700Medicare ID - Type Unspecified