Provider Demographics
NPI:1548213143
Name:LISA A RINK FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:LISA A RINK FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RINK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-672-1115
Mailing Address - Street 1:217 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1703
Mailing Address - Country:US
Mailing Address - Phone:856-672-1115
Mailing Address - Fax:856-672-9111
Practice Address - Street 1:217 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1703
Practice Address - Country:US
Practice Address - Phone:856-672-1115
Practice Address - Fax:856-672-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0039446Medicaid
NJ0039446Medicaid